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    Self Declaration Form Details For International Arriving Passengers

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    mobile wala
    This self-declaration form provides details for an international arriving passenger named Abdul Sai from United Arab Emirates to Patna, India. Key information includes his flight details, passport and testing information, domestic travel plans, contact information, health details, and cities visited in the last 14 days. The form confirms the passenger agrees to follow Ministry of Health guidelines regarding quarantine, self-monitoring, and testing.

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

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    mobile wala
    109 views2 pages
    This self-declaration form provides details for an international arriving passenger named Abdul Sai from United Arab Emirates to Patna, India. Key information includes his flight details, passport and testing information, domestic travel plans, contact information, health details, and cities visited in the last 14 days. The form confirms the passenger agrees to follow Ministry of Health guidelines regarding quarantine, self-monitoring, and testing.

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    Hi

    Original Title

    SR2105030031994

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    This self-declaration form provides details for an international arriving passenger named Abdul Sai from United Arab Emirates to Patna, India. Key information includes his flight details, passport and testing information, domestic travel plans, contact information, health details, and cities visited in the last 14 days. The form confirms the passenger agrees to follow Ministry of Health guidelines regarding quarantine, self-monitoring, and testing.

    Copyright:

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

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    mobile wala
    This self-declaration form provides details for an international arriving passenger named Abdul Sai from United Arab Emirates to Patna, India. Key information includes his flight details, passport and testing information, domestic travel plans, contact information, health details, and cities visited in the last 14 days. The form confirms the passenger agrees to follow Ministry of Health guidelines regarding quarantine, self-monitoring, and testing.

    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

    T PASSENGER DETAILS

    Registration Number
    @
    SR2105030031994

    Name Date of Birth


    ABDUL SAI 09/12/1990

    Flight Number Seat Number


    SG137 01

    PNR Number Nationality


    EDFQVT INDIA

    Passport Number Passport Copy Uploaded


    N6127864 No

    Date of Arrival Country of Origin


    03/05/2021 UNITED ARAB EMIRATES

    Are you taking a connecting Domestic flight? Domestic Connecting Flight


    YES PATNA

    RT-PCR Negative Certificate Uploaded


    Yes

    City of Origin First Airport of Entry


    PATNA DELHI AIRPORT

    First Airport of Entry State/Union Territories Final Destination - House Number


    NEW DELHI CHAPRA HOUSE NO

    Final Destination Street/Village Final Destination Tehsil


    CHAPRA CHAPRA

    Final Destination State/Union Territories Final Destination District/City


    BIHAR CHAPRA

    Final Destination Pincode Contact Number


    841460 +919661282425

    Alternate Contact Number Email ID


    [email protected]

    Fever Diabetes
    No No
    Cough Hypertension
    No No

    Respiratory Distress Bronchial Asthma


    No No

    Cancer
    No

    Unde Immunosuppresive Therapy


    No

    Post Transplant Patients


    No

    Details of the Cities / Countries visited in last 14 days? How many passengers are travelling?
    DUBAI 1

    I/We have agreed to the following terms:

    I agree to the guidelines issued by Ministry of Health & Family Welfare.

    The above information is correct and in case of any wrong information and non-cooperation, I will be liable for action
    under the law. I also agree to the terms & conditions.

    I undertake to quarantine/self monitor/take the self paid RTPCR test on arrival as applicable to me as per the latest
    MOHFW guidelines.

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