INFORMATION REQUEST FORM


A

FOR IMMIGRATION PURPOSES

First Name    

Last Name   

Date of Birth   YYYY-MM-DD     

Sex  M  F            Nationality                    Race                 Married    Yes        No

Permanent Home Address   

Occupation   

Postal Address 

Telephone Number         

Email Address

Have you ever visited South Africa or Mozambique  

If yes, short description 

Passport date of issue    YYYY-MM-DD     Passport date of expiry YYYY-MM-DD

Passport Number            


B

FOR MOZAMBIQUE, HUNTING PERMIT, this section must be completed

Copy of Passport  Upload a copy of your passport          Passport Photo  Upload a passport photo

Port of Entry                 Safari Company

Mozambique Province to Hunt;    Manica       Gaza 


C

TRAVEL ARRANGEMENTS

For your hunting destination, would you prefer    South Africa      Mozambique   

Number of days     Safari Dates   To 

Alternative dates if dates are not available  To

Arrival Date YYYY-MM-DD      Departure Date YYYY-MM-DD

Place & date of departure      Airline and flight number 

Place & date of arrival in Africa        Airline and flight number  

Would you prefer a charter or drive by vehicle to camp from airport  Charter   Drive


D

FIREARMS DETAILS;

First Rifle  

Make    Caliber       Serial Number  No of rounds (Mozambique exact no)

 Second Rifle

Make    Caliber       Serial Number  No of rounds (Mozambique exact no)

 Third Rifle

Make    Caliber     Serial Number    No of rounds (Mozambique exact no)

Would you like to use a Company rifle if available   Yes      No


E

FOR MOZAMBIQUE RIFLE IMPORTS this section must be completed

Copy  of firearm licenses;    1st rifle     2nd rifle    

3rd rifle

For the ammunition be sure to fill in the exact number of rounds to be taken into Mozambique


F

FOR SAFARI PURPOSES (To assist in making your hunt more enjoyable) 

Camp arrangements (the relationship of the members of your group affects accommodation, so please state how you would like accommodation arranged).



Trophies required in order of priority 


Factors that are important to you;  Trophy Quality        Price           Ease of hunting         Accommodation         Climate

Do you have trouble; Roughing it      Climbing       Walking       Hot dry climate        Hot humid climate      

 Cold climate       None

Indicate one and explain:

 I hunt only for the biggest trophies 

 I hunt for representative trophies   

 I will pass representative animals in search of a record book animal 

Food that you like or dislike

Alcoholic beverages, mineral water preferred (these must be sent to the camp prior to your safari)


Medical problems: (see your doctor for antimalarial advice)    Is your health fitness:   Good       Fair      Poor

Do you have any medical handicap, allergies, that might affect your safari       Yes     No

Explain

Do you wear subscription glasses or contact lenses:     Yes    No


Indicate any other information you feel will help us make your safari more enjoyable for you