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Travel and Health Declaration Form

To ensure the health and safety of our customers, employees and the community, we would need your help to complete this health declaration form. We seek your understanding and thank you for your patience.

Is anyone of you suffering from any fever, flu, cold, sore throat, cough, running nose or any other flu like symptoms? *
Yes No

Has anyone of you travelled out of {{resCountry}} in the past 14 days? *
Yes No

Has any of your family members/friends (living with you) travelled out of {{resCountry}} in the past 14 days? *
Yes No

Has anyone of you been in contact with an infected patient of Covid-19 in the past 14 days? *
Yes No

* mandatory