Seafarer Quarantine Clearance Declaration
Personal Information
Full Name
Nationality
Passport/Seaman's Book No.
Rank/Position
Date of Birth
Vessel Name
Quarantine Details
Date of Arrival
Quarantine Location
Quarantine Period (From - To)
Health Authority / Agency in Charge
Declaration
I hereby declare that I have completed the mandatory quarantine as required by local authorities, and I am fit to join the vessel / to disembark.
Date
Name & Signature