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    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    The document contains a self declaration form for international arriving passengers with fields for passenger details like name, passport number, flight details, contact information, health details, cities visited and a declaration agreeing to follow quarantine guidelines.

    Copyright:

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

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    9 views2 pages
    The document contains a self declaration form for international arriving passengers with fields for passenger details like name, passport number, flight details, contact information, health details, cities visited and a declaration agreeing to follow quarantine guidelines.

    Original Title

    SR2108150209615

    Copyright

    © © All Rights Reserved

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    The document contains a self declaration form for international arriving passengers with fields for passenger details like name, passport number, flight details, contact information, health details, cities visited and a declaration agreeing to follow quarantine guidelines.

    Copyright:

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

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    The document contains a self declaration form for international arriving passengers with fields for passenger details like name, passport number, flight details, contact information, health details, cities visited and a declaration agreeing to follow quarantine guidelines.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    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
    @
    SR2108150209615

    Name Date of Birth


    ARJUN KUMAR RAM 06/04/1985

    Flight Number Seat Number


    J91409 DNK

    PNR Number Nationality


    HY62UQ INDIA

    Passport Number Passport Copy Uploaded


    S5886775 No

    Date of Arrival Country of Origin


    17/08/2021 KUWAIT

    Are you taking a connecting Domestic flight? Domestic Connecting Flight


    NO

    RT-PCR Negative Certificate Uploaded


    Yes

    City of Origin First Airport of Entry


    KUWAIT DELHI AIRPORT

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


    NEW DELHI SHER

    Final Destination Street/Village Final Destination Tehsil


    SIDHWALIYA GOPALGANJ

    Final Destination State/Union Territories Final Destination District/City


    BIHAR GOPALGANJ

    Final Destination Pincode Contact Number


    841407 +919006378705

    Alternate Contact Number Email ID


    DEEPTHI@TRAVELCLUB.COM.KW

    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?
    NO 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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