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    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    This document contains a self-declaration form for an international arriving passenger named Venkata Babu Mailapilli. The form includes details such as his flight information from Kuwait to Hyderabad, India, vaccination details, health conditions, locations visited in the last 14 days, and a statement agreeing to follow Ministry of Health guidelines upon arrival.

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    © All Rights Reserved
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    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    168 views2 pages
    This document contains a self-declaration form for an international arriving passenger named Venkata Babu Mailapilli. The form includes details such as his flight information from Kuwait to Hyderabad, India, vaccination details, health conditions, locations visited in the last 14 days, and a statement agreeing to follow Ministry of Health guidelines upon arrival.

    Original Title

    SR2208020071885

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    This document contains a self-declaration form for an international arriving passenger named Venkata Babu Mailapilli. The form includes details such as his flight information from Kuwait to Hyderabad, India, vaccination details, health conditions, locations visited in the last 14 days, and a statement agreeing to follow Ministry of Health guidelines upon arrival.

    Copyright:

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

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    This document contains a self-declaration form for an international arriving passenger named Venkata Babu Mailapilli. The form includes details such as his flight information from Kuwait to Hyderabad, India, vaccination details, health conditions, locations visited in the last 14 days, and a statement agreeing to follow Ministry of Health guidelines upon arrival.

    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 V

    Registration Number Date of Birth


    SR2208020071885 04/12/1985

    Name Gender
    VENKATA BABU MAILAPILLI MALE

    Flight Number Seat Number


    6E1906 DNK

    PNR Number Nationality


    QWL6UZ INDIA

    Passport Number Country of Origin


    Z3825961 KUWAIT

    Date of Arrival Domestic Connecting Flight


    08/08/2022 6E581

    Are you taking a connecting Domestic flight? Date of RT-PCR Test Taken
    YES -

    RT-PCR Negative Certificate Uploaded Date of Final Dose of Vaccination


    No 14/03/2022

    Vaccination Certificate Uploaded First Airport of Entry


    Yes HYDERABAD AIRPORT

    City of Origin Final Destination - House Number


    KUWAIT 71-31-1791

    First Airport of Entry State/Union Territories Final Destination Tehsil


    TELANGANA GANDHIGRAM

    Final Destination Street/Village Final Destination District/City


    KAKARALOYA VISAKHAPATANAM

    Final Destination State/Union Territories Contact Number


    ANDHRA PRADESH +96599752096

    Final Destination Pincode Email ID


    530005 DEEPTHI@TRAVELCLUB.COM.KW

    Alternate Contact Number Diabetes


    No
    Fever Hypertension
    No No

    Cough Bronchial Asthma


    No No

    Respiratory Distress Cancer


    No No

    Unde Immunosuppresive Therapy


    No

    Post Transplant Patients


    No

    Details of the Cities / Countries visited in last 14 days? Location of Final Vaccination dose
    NONE Kuwait

    Are you fully vaccinated?


    YES

    How many passengers are travelling with you in the same flight and to the same final destination?
    1

    I/We have agreed to the following terms:

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

    I, the primary applicant, verify that the information filled is correct and agree to be contacted for the co - passenger
    contact tracing. In case of any default, the primary applicant will be liable for punishable offences under the provisions of
    the relevant Indian Laws. 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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