Travel Declaration Form

All travelers entering this country/city from the outside are required to fill out this form in order to make sure that they understand the travel requirements.

Name

First NameLast Name

Phone Number

Please enter a valid phone number.

Email

example@example.com

Date of Birth

Date

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Person

First NameLast Name

Emergency Contact Person No.

Please enter a valid phone number.

Country Destination

City Destination

Country Origin

Schedule Flight

Date

Hour MinutesAM/PM Option

Have you been in contact with someone who had traveled overseas in the last 14 days?

YesNo

If yes, when is the contact date?

Date

Can we get your consent for a temperature check upon arrival?

YesNo

Have you been tested for COVID-19?

YesNo

If yes, when did you undergo COVID-19 testing?

Date

What is the result of the COVID-19 testing?

NegativePositive

Have you received the COVID-19 vaccine?

YesNo

If yes, when did you get vaccinated?

Date

Where did you get vaccinated?

Is it a first dose or second dose?

First doseSecond dose

I have read and understood the travel requirements and I will abide by them.I confirm that all information I entered in this form is accurate and true to the best of my knowledge.I understand that all passengers will undergo COVID-19 travel protocols.I declare that I am physically and mentally fit to travel overseas.

Signature

Date Signed

Date

Please be reminded that failure to tell the truth or false declaration is considered a criminal offense.