COVID-19 Pre-Travel Health Declaration
Passenger Information
Full Name
Passport/ID Number
Flight Number
Seat Number
Contact Details
Phone Number
Email Address
Health Status
Fever
Cough
Shortness of breath
Sore throat
Loss of taste or smell
Travel History (past 14 days)
Countries Visited
Exposure History
Contact with confirmed COVID-19 case
Visited healthcare facility for COVID-19
I confirm that the above information is accurate and complete to the best of my knowledge.
Signature:
Date: