Do you have the following symptoms in the last 5 days
Fever/Shortness of Breath/Cough
Nasal Congestion/Runny Nose & Sore Throat/Fatigue/Diarrhea
Abnormal sense of smell and taste
Is your 48h PCR test result Positive?
Did you have contact with individuals who have been diagnosed or has been
suspected of having been infected with Covid-19 virus in the last 7days?
Did you travel or have resided in middle or high risk areas in the last 7 days?
Are you currently under “Home Quarantine” for medical observation?
I hereby declare that the above information provided is true as reported.
Passport: ____________
Phone: ____________
Date: ____________
* Note : Information declared in this questionnaire is deemed true as reported. You can be liable to legal responsibilities should the information be untrue and has caused severe consequences.