Guest Self Declaration Form
Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Guest Name
Gender
Contact details
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email ID (Optional)
example@example.com
Nationality
Permanent Address,
Coming from (with details of destination and route)
Going to (with details of destination and route)
Mode of transportation while going back with details of flight/ train
Arrival date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Arrival Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Checkout Date
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Check Out Time
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Room no./ Floor no.
Purpose of visit (Optional)
Travel history
Have you travelled abroad during 2020
Yes
No
Have you been in contact with people being infected or diagnosed with COVID 19
Yes
No
If Yes, Please Enter Details
Type a question
Rows
Yes
No
Fever
1
2
Cough
3
4
Shortness of Breath
5
6
Persistent Pain in Chest
7
8
Signature
Submit
Should be Empty: