Travel Attestation Form

Travel Attestation Form
All individuals entering our State who do not fall within certain, limited exemptions must complete this form upon or prior to entry. Failure to complete the form and comply with the precautionary measures may result in a capital punishment.
Following the entrance all travellers are required to self quarantine for 10 days unless:
1. are coming from a low-risk state
2. can procedure, on request, proof of negative test result taken not longer than 72 hours before arrival
3. meet the exemption criteria
Name
First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Home Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Country/State Before Arrival
Arrival Date
MonthDayYear
Date
Departure Date (optional)
MonthDayYear
Date
Where you are staying
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Dependants
COVID-19 Health Status
Other
Signature
Clear
Should be Empty: