Pilgrimage Tour Health Declaration Form
Full Name
Passport Number
Date of Birth
Contact Number
Country
Medical History
Do you have any chronic/underlying medical conditions?
Are you currently on any medication? If yes, please specify.
Any allergies (including food/medicine)?
Have you received all required vaccinations for this pilgrimage tour?
Yes
No
Recent Health Status
Have you experienced any of the following symptoms in the past 14 days?
Fever
Cough
Sore Throat
Difficulty Breathing
None of the above
Have you traveled abroad or been in contact with someone diagnosed with a contagious disease in the last 21 days?
Yes
No
I hereby declare that the information provided above is true and complete to the best of my knowledge.
Date
Signature