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    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 Quarashi Mohammad Rayaz. The form includes details such as his registration number, date of birth, gender, flight information, passport details, vaccination details, health conditions, countries visited in the last 14 days, and contact information. At the end, the passenger agrees to follow all Ministry of Health guidelines regarding quarantine, self-monitoring, and COVID-19 testing. He also agrees to be contacted for contact tracing of any co-passengers and acknowledges liability for any defaults under Indian law.

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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

    Koteswar Mandava
    149 views2 pages
    This document contains a self-declaration form for an international arriving passenger named Quarashi Mohammad Rayaz. The form includes details such as his registration number, date of birth, gender, flight information, passport details, vaccination details, health conditions, countries visited in the last 14 days, and contact information. At the end, the passenger agrees to follow all Ministry of Health guidelines regarding quarantine, self-monitoring, and COVID-19 testing. He also agrees to be contacted for contact tracing of any co-passengers and acknowledges liability for any defaults under Indian law.

    Original Description:

    Original Title

    SR2208010015174

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    This document contains a self-declaration form for an international arriving passenger named Quarashi Mohammad Rayaz. The form includes details such as his registration number, date of birth, gender, flight information, passport details, vaccination details, health conditions, countries visited in the last 14 days, and contact information. At the end, the passenger agrees to follow all Ministry of Health guidelines regarding quarantine, self-monitoring, and COVID-19 testing. He also agrees to be contacted for contact tracing of any co-passengers and acknowledges liability for any defaults under Indian law.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    149 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 Quarashi Mohammad Rayaz. The form includes details such as his registration number, date of birth, gender, flight information, passport details, vaccination details, health conditions, countries visited in the last 14 days, and contact information. At the end, the passenger agrees to follow all Ministry of Health guidelines regarding quarantine, self-monitoring, and COVID-19 testing. He also agrees to be contacted for contact tracing of any co-passengers and acknowledges liability for any defaults under Indian law.

    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


    SR2208010015174 04/04/1973

    Name Gender
    QUARASHI MOHAMMAD RAYAZ MALE

    Flight Number Seat Number


    EY304 DNK

    PNR Number Nationality


    SZAILE INDIA

    Passport Number Country of Origin


    P8553731 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 24/07/2022

    Vaccination Certificate Uploaded First Airport of Entry


    Yes DELHI AIRPORT

    City of Origin Final Destination - House Number


    KUWAIT BHATIDHAR

    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.

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