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    SR2301140214501

    Uploaded by

    Emesi Etavias
    This document contains a self-declaration form for international arriving passengers with details like name, nationality, passport number, flight details, dates of COVID tests, address and state of final destination in India, quarantine requirements, and agreement to follow Ministry of Health guidelines. The passenger declares they have not visited any other countries in the last 14 days and are not a transit passenger. They agree to quarantine, testing and being contacted by authorities as required and certify the information provided is correct.

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    SR2301140214501

    Uploaded by

    Emesi Etavias
    17 views1 page
    This document contains a self-declaration form for international arriving passengers with details like name, nationality, passport number, flight details, dates of COVID tests, address and state of final destination in India, quarantine requirements, and agreement to follow Ministry of Health guidelines. The passenger declares they have not visited any other countries in the last 14 days and are not a transit passenger. They agree to quarantine, testing and being contacted by authorities as required and certify the information provided is correct.

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    Original Title

    1673653557190_SR2301140214501

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    This document contains a self-declaration form for international arriving passengers with details like name, nationality, passport number, flight details, dates of COVID tests, address and state of final destination in India, quarantine requirements, and agreement to follow Ministry of Health guidelines. The passenger declares they have not visited any other countries in the last 14 days and are not a transit passenger. They agree to quarantine, testing and being contacted by authorities as required and certify the information provided is correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    17 views1 page

    SR2301140214501

    Uploaded by

    Emesi Etavias
    This document contains a self-declaration form for international arriving passengers with details like name, nationality, passport number, flight details, dates of COVID tests, address and state of final destination in India, quarantine requirements, and agreement to follow Ministry of Health guidelines. The passenger declares they have not visited any other countries in the last 14 days and are not a transit passenger. They agree to quarantine, testing and being contacted by authorities as required and certify the information provided is correct.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    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
    SR2301140214501

    Name Flight Number


    LALNGAIHZUALI 6E42

    Nationality Passport Number


    INDIA P6834812

    Date of Arrival Country of Departure ( Origin )


    14/01/2023 SINGAPORE

    Date of RT-PCR Test Taken RT-PCR Negative Certificate Upload


    13/01/2023 YES

    First Airport of Entry Final Destination Address


    KOLKATA AIRPORT AIZAWL THUAMPUI T24

    Final Destination State/Union Territories Final Destination District/City


    MIZORAM AIZAWL

    Final Destination Pincode Mobile Number


    796001 +918794879826

    Email ID Details of the Countries visited in last 14


    days?
    MSI.SAIVATE@GMAIL.COM NONE

    Are you a Transit Passenger? Country of Transit


    NO -

    Transit Flight Number ( Arriving in India )


    -

    How many passengers are travelling with you in the same flight and to the same final destination?
    0

    I/We have agreed to the following terms:


    I agree to the guidelines issued by Ministry of Health & Family Welfare.
    I undertake to quarantine/self monitor/take the self paid Covid-19 test on arrival as applicable to me as per the latest
    MOHFW guidelines.
    I, the primary applicant/passenger, authorise to be contacted by the Ministry of Health and Family Welfare, Government
    of India, for the purpose of identification and related checks of my co-passenger(s), if required. 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, the primary applicant, certify that the information filled is correct and true.
    For latest travel advisory kindly visit the link, https://www.newdelhiairport.in/covid19

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