Scribd Logo
Upload

Welcome to Scribd!

  • 42 views

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    This document contains a self-declaration form for an international arriving passenger named Mohd Shakeel from Kuwait. The form provides details such as his registration number, date of birth, gender, flight details, passport information, dates of arrival and vaccination, vaccination certificate information, addresses for final destination in India, contact information and health details. At the end, the passenger agrees to follow all guidelines issued by the Ministry of Health and Family Welfare in India and to quarantine, self-monitor or take COVID tests as required.

    Copyright:

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

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    42 views2 pages
    This document contains a self-declaration form for an international arriving passenger named Mohd Shakeel from Kuwait. The form provides details such as his registration number, date of birth, gender, flight details, passport information, dates of arrival and vaccination, vaccination certificate information, addresses for final destination in India, contact information and health details. At the end, the passenger agrees to follow all guidelines issued by the Ministry of Health and Family Welfare in India and to quarantine, self-monitor or take COVID tests as required.

    Original Title

    SR2208010014579

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document contains a self-declaration form for an international arriving passenger named Mohd Shakeel from Kuwait. The form provides details such as his registration number, date of birth, gender, flight details, passport information, dates of arrival and vaccination, vaccination certificate information, addresses for final destination in India, contact information and health details. At the end, the passenger agrees to follow all guidelines issued by the Ministry of Health and Family Welfare in India and to quarantine, self-monitor or take COVID tests as required.

    Copyright:

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

    Self Declaration Form Details For International Arriving Passengers

    Uploaded by

    Koteswar Mandava
    This document contains a self-declaration form for an international arriving passenger named Mohd Shakeel from Kuwait. The form provides details such as his registration number, date of birth, gender, flight details, passport information, dates of arrival and vaccination, vaccination certificate information, addresses for final destination in India, contact information and health details. At the end, the passenger agrees to follow all guidelines issued by the Ministry of Health and Family Welfare in India and to quarantine, self-monitor or take COVID tests as required.

    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 Date of Birth


    SR2208010014579 05/04/1976

    Name Gender
    MOHD SHAKEEL MALE

    Flight Number Seat Number


    EY304 DNK

    PNR Number Nationality


    MYTNLN INDIA

    Passport Number Country of Origin


    P9718509 KUWAIT

    Date of Arrival Domestic Connecting Flight


    02/08/2022

    Are you taking a connecting Domestic flight? Date of RT-PCR Test Taken
    NO -

    RT-PCR Negative Certificate Uploaded Date of Final Dose of Vaccination


    No 31/08/2021

    Vaccination Certificate Uploaded First Airport of Entry


    Yes DELHI AIRPORT

    City of Origin Final Destination - House Number


    KUWAIT CHHAJLA

    First Airport of Entry State/Union Territories Final Destination Tehsil


    NEW DELHI POONCH

    Final Destination Street/Village Final Destination District/City


    MANDHAR POONCH

    Final Destination State/Union Territories Contact Number


    JAMMU & KASHMIR +96599752096

    Final Destination Pincode Email ID


    185211 [email protected]

    Alternate Contact Number Diabetes


    No
    Fever Hypertension
    No No

    Cough Bronchial Asthma


    No No

    Respiratory Distress Cancer


    No No

    Unde Immunosuppresive Therapy


    No

    Post Transplant Patients


    No

    Details of the Cities / Countries visited in last 14 days? Location of Final Vaccination dose
    NONE Kuwait

    Are you fully vaccinated?


    YES

    How many passengers are travelling with you in the same flight and to the same final destination?
    1

    I/We have agreed to the following terms:

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

    I, the primary applicant, verify that the information filled is correct and agree to be contacted for the co - passenger
    contact tracing. 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 undertake to quarantine/self monitor/take the self paid RTPCR test on arrival as applicable to me as per the latest
    MOHFW guidelines.

    You might also like