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    Self Declaration Form Details For International Arriving Passengers

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    This self-declaration form contains details of an international arriving passenger such as name, date of birth, flight information, contact details, health details including any COVID-19 symptoms, places visited in the last 14 days, and a declaration agreeing to follow quarantine guidelines in India. The passenger declares that the information provided is correct and they will be liable for any legal action if it is found to be incorrect or uncooperative.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    gmail gmail
    34 views2 pages
    This self-declaration form contains details of an international arriving passenger such as name, date of birth, flight information, contact details, health details including any COVID-19 symptoms, places visited in the last 14 days, and a declaration agreeing to follow quarantine guidelines in India. The passenger declares that the information provided is correct and they will be liable for any legal action if it is found to be incorrect or uncooperative.

    Original Title

    SR2103060138738

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    This self-declaration form contains details of an international arriving passenger such as name, date of birth, flight information, contact details, health details including any COVID-19 symptoms, places visited in the last 14 days, and a declaration agreeing to follow quarantine guidelines in India. The passenger declares that the information provided is correct and they will be liable for any legal action if it is found to be incorrect or uncooperative.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    34 views2 pages

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    gmail gmail
    This self-declaration form contains details of an international arriving passenger such as name, date of birth, flight information, contact details, health details including any COVID-19 symptoms, places visited in the last 14 days, and a declaration agreeing to follow quarantine guidelines in India. The passenger declares that the information provided is correct and they will be liable for any legal action if it is found to be incorrect or uncooperative.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Self Declaration form details for international arriving passengers

    Applications are being accepted on behalf of the Ministry of Health and Family Welfare, Government of India

    PASSENGER DETAILS

    Registration Number
    @
    SR2103060138738

    Name Date of Birth


    KISHAN RAM 01/07/1988

    Flight Number Seat Number


    E9206 8E

    PNR Number Nationality


    HRVQWR INDIA

    Passport Number Passport Copy Uploaded


    L8035834 No

    Date of Arrival Country of Origin


    07/03/2021 SAUDI ARABIA

    Are you taking a connecting Domestic flight? Domestic Connecting Flight


    NO

    RT-PCR Negative Certificate Uploaded


    Yes

    City of Origin First Airport of Entry


    DELHI DELHI AIRPORT

    First Airport of Entry State/Union Territories Final Destination - House Number


    NEW DELHI 8-HOUSE

    Final Destination Street/Village Final Destination Tehsil


    DHOLKNI BAJIYON KI DHANI

    Final Destination State/Union Territories Final Destination District/City


    DELHI RAJISTAN

    Final Destination Pincode Contact Number


    341302 +919982846850

    Alternate Contact Number Email ID


    OFTRV77@GMAIL.COM

    Fever Diabetes
    No No
    Cough Hypertension
    No No

    Respiratory Distress Bronchial Asthma


    No No

    Cancer
    No

    Unde Immunosuppresive Therapy


    No

    Post Transplant Patients


    No

    Details of the Cities / Countries visited in last 14 days? How many passengers are travelling?
    IN SAUDI ARABIA RIYADH IN PAST 14 DAYS 1

    I/We have agreed to the following terms:

    I agree to the guidelines issued by Ministry of Health & Family Welfare.

    The above information is correct and in case of any wrong information and non-cooperation, I will be liable for action
    under the law. I also agree to the terms & conditions.

    I undertake to quarantine/self monitor/take the self paid RTPCR test on arrival as applicable to me as per the latest
    MOHFW guidelines.

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