Passenger Locator Form

You are required to carry a certificate of a negative RT-PCR or antigen (rapid) test result to be allowed by the border authorities to
enter the country. The certificates should be written in English and bear the name and passport/national ID number of the traveler.
You may be retested upon arrival at your point of entry in Greece.

1. Personal
. . . . . . . Information -··············-······-·······-·······-······-·······-······-·

Last Name / Middle / First Name Sex / Age

Serebrin / - / Mykhailo Male / 40

Mobile Phone Number Business Phone Number Home Phone Number

Unique Code
+380674844815 - -
7171062526
Other Phone Number Email Passport
Date Submitted
- irina@nikita.com.ua FL457434
2021-10-09

1. .Transportation
.... Information: Aircraft Flight Information
Airline name Flight number

Skyup PQ521

Date of arrival Point of Entry in the Country

2021-10-10 Heraklion

Connection Flight Information

Airline name Flight number Date of arrival

- - -

I Permanent Address
--------
Country State / Province City

Ukraine Odessa Odessa

Street (Name, Number, ZIP) Apartment Number / Previously Visited Country

Cabin Number
Gogolya 1/3 65000 -

1 Temporary
..... Address --------------------------------------------------------------------------------------
Country State / Province City

Greece - Katsikia

Street (Name, Number, ZIP) Hotel Name (If Any) / Apartment Number / Cabin
Cruise Ship Name Number
Katsikia 72150 Villa friends -
 Passenger Locator Form

1. .Secondary
. . . . . . . . . . . . . . . . .Temporary
. . . . . . . . . . . . . . . . .Address
..........................................................
Country State / Province City

Street (Name, Number, ZIP) Hotel Name (If Any) / Cruise Apartment Number /
Ship Name Cabin Number

1. .Emergency
. . . . . . . . . . . . . . . . . .Contact
. . . . . . . . . . . . Information
..............................................................
Last (Family) Name First (Given) Name Country / City

Piliaieva Iryna Ukraine / Odessa

Mobile Phone Number Other Phone Number Email

+380956505123 - irina@nikita.com.ua

1. . Travel
. . . . . . . . . . Companions
. . . . . . . . . . . . . . . . . . . . –. . .Family
...........................................................
Number Last Name / First Name / Passport / ID Age Seat Number

1. . .Travel
. . . . . . . . . .Companions
. . . . . . . . . . . . . . . . . . . .–. . Non-Family
. . . . . . . . . . . . . . . . . ./. .Non-Same
. . . . . . . . . . . . . . . .Household
.......................
Number Last Name / First Name / Passport / ID Group (Tour, Team, Business, Other)

1. . .Digital
. . . . . . . . . . Certificate
.................................................................................
First Name Last Name Passport / ID Number Expiration

Mykhailo Serebrin -/ - -

Type Manufacturer Country Certificate ID

Other Digital / Non Unknown - -
Digital