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    SR2210050259135

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    Inder Singh
    This self-declaration form contains details for two passengers, Lakhwinder Singh and Inderjeet Kaur, traveling together from the United States to Amritsar, India. Both passengers are fully vaccinated US citizens arriving on flight AF226 on October 7, 2022. They will quarantine as required by the Indian Ministry of Health and have agreed to all terms on the form including testing and contact tracing if needed.

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    SR2210050259135

    Uploaded by

    Inder Singh
    15 views2 pages
    This self-declaration form contains details for two passengers, Lakhwinder Singh and Inderjeet Kaur, traveling together from the United States to Amritsar, India. Both passengers are fully vaccinated US citizens arriving on flight AF226 on October 7, 2022. They will quarantine as required by the Indian Ministry of Health and have agreed to all terms on the form including testing and contact tracing if needed.

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    SR2210050259135 (2)

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    This self-declaration form contains details for two passengers, Lakhwinder Singh and Inderjeet Kaur, traveling together from the United States to Amritsar, India. Both passengers are fully vaccinated US citizens arriving on flight AF226 on October 7, 2022. They will quarantine as required by the Indian Ministry of Health and have agreed to all terms on the form including testing and contact tracing if needed.

    Copyright:

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

    SR2210050259135

    Uploaded by

    Inder Singh
    This self-declaration form contains details for two passengers, Lakhwinder Singh and Inderjeet Kaur, traveling together from the United States to Amritsar, India. Both passengers are fully vaccinated US citizens arriving on flight AF226 on October 7, 2022. They will quarantine as required by the Indian Ministry of Health and have agreed to all terms on the form including testing and contact tracing if needed.

    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 V

    Registration Number
    SR2210050259135

    Name Flight Number


    LAKHWINDER SINGH AF226

    Nationality Passport Number


    UNITED STATES 592291214

    Date of Arrival Country of Departure ( Origin )


    07/10/2022 UNITED STATES

    Are you fully vaccinated? Location of Final Vaccination dose


    Yes United States

    Date of Final Dose of Vaccination Date of RT-PCR Test Taken


    15/07/2022 -

    I hereby certify that I am vaccinated for COVID-19 and will produce the supporting document for verification by the
    competent authority on arrival at Indian airport.

    First Airport of Entry Final Destination Address


    DELHI AIRPORT 47G MOHINDRA COLONY , AMRITSAR
    143001

    Final Destination State/Union Territories Final Destination District/City


    PUNJAB AMRITSAR

    Final Destination Pincode Mobile Number


    143001 +917087716347

    Email ID
    LSINGH4@YAHOO.COM

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

    CO PASSENGER DETAILS

    Passenger 2

    Name Flight Number


    INDERJEET KAUR AF226
    Nationality Passport Number
    UNITED STATES 552360385

    Date of Arrival Country of Departure ( Origin )


    07/10/2022 UNITED STATES

    Is the passenger less than 5 years of age? Date of Birth


    No -

    Are you fully vaccinated? Location of Final Vaccination dose


    Yes United States

    Date of Final Dose of Vaccination Date of RT-PCR Test Taken


    15/07/2022 -

    I hereby certify that I am vaccinated for COVID-19 and will produce the supporting document for verification by the
    competent authority on arrival at Indian airport.

    First Airport of Entry Final Destination Address


    DELHI AIRPORT 47G MOHINDRA COLONY , AMRITSAR
    143001

    Final Destination State/Union Territories Final Destination District/City


    PUNJAB AMRITSAR

    Final Destination Pincode Mobile Number


    143001 +917087716347

    Email ID
    LSINGH4@YAHOO.COM

    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.

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