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    SR 2209200974760

    Uploaded by

    Ajay Sharma

    Copyright:

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

    SR 2209200974760

    Uploaded by

    Ajay Sharma
    10 views2 pages

    Original Title

    Sr 2209200974760

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    Copyright:

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

    SR 2209200974760

    Uploaded by

    Ajay Sharma

    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
    SR2209200974760

    Name Flight Number


    DAVINDER 788TRD

    Nationality Passport Number


    INDIA P2067994

    Date of Arrival Country of Departure ( Origin )


    21/09/2022 AUSTRALIA

    Are you fully vaccinated? Location of Final Vaccination dose


    Yes India

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


    29/07/2022 -

    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


    AMRITSAR AIRPORT F21/540 SANDHU COLONY
    MAJITHAROAD

    Final Destination State/Union Territories Final Destination District/City


    PUNJAB AMRITSAR

    Final Destination Pincode Mobile Number


    143001 +917009237694

    Email ID
    RUBAL1989@HOTMAIL.COM

    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.

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