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Airport Declaration India

This self-declaration form contains details for two international passengers, Varun Mahajan and Priyanka Chauhan, arriving in India from Singapore on flight 6E42. Both passengers certify that they are fully vaccinated against COVID-19 and will produce supporting documents to authorities. They will quarantine as required by the Ministry of Health and have agreed to terms including being contacted for verification.

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Robert Sinatra
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52 views

Airport Declaration India

This self-declaration form contains details for two international passengers, Varun Mahajan and Priyanka Chauhan, arriving in India from Singapore on flight 6E42. Both passengers certify that they are fully vaccinated against COVID-19 and will produce supporting documents to authorities. They will quarantine as required by the Ministry of Health and have agreed to terms including being contacted for verification.

Uploaded by

Robert Sinatra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Self Declaration form details for international arriving passengers

Applications are being accepted on behalf of the Ministry of Health and Family Welfare, Government of India

___ PASSENGER DETAILS V

Registration Number
SR2211211325154

Name Flight Number


VARUN MAHAJAB 6E42

Nationality Passport Number


INDIA M3274676

Date of Arrival Country of Departure ( Origin )


22/11/2022 SINGAPORE

Are you fully vaccinated? Location of Final Vaccination dose


Yes India

Date of Final Dose of Vaccination Date of RT-PCR Test Taken


12/11/2021 -

I hereby certify that I am vaccinated for COVID-19 and will produce the supporting document for verification by the
competent authority on arrival at Indian airport.

First Airport of Entry Final Destination Address


KOLKATA AIRPORT 422, S2 BLOCK, RAHEJA TEACHERS
APARTMENTS, SECTOR 31, GURGAON

Final Destination State/Union Territories Final Destination District/City


HARYANA GURUGRAM

Final Destination Pincode Mobile Number


122003 +919610504089

Email ID
[email protected]

How many passengers are travelling with you in the same flight and to the same final destination?
1

CO PASSENGER DETAILS

Passenger 2

Name Flight Number


PRIYANKA CHAUHAN 6E42
Nationality Passport Number
INDIA L1974937

Date of Arrival Country of Departure ( Origin )


22/11/2022 SINGAPORE

Is the passenger less than 5 years of age? Date of Birth


No -

Are you fully vaccinated? Location of Final Vaccination dose


Yes India

Date of Final Dose of Vaccination Date of RT-PCR Test Taken


14/09/2021 -

I hereby certify that I am vaccinated for COVID-19 and will produce the supporting document for verification by the
competent authority on arrival at Indian airport.

First Airport of Entry Final Destination Address


KOLKATA AIRPORT 422, S2 BLOCK, RAHEJA TEACHERS
APARTMENTS, SECTOR 31, GURGAON

Final Destination State/Union Territories Final Destination District/City


HARYANA GURUGRAM

Final Destination Pincode Mobile Number


122003 +919610504089

Email ID
[email protected]

I/We have agreed to the following terms:

I agree to the guidelines issued by Ministry of Health & Family Welfare.

I undertake to quarantine/self monitor/take the self paid Covid-19 test on arrival as applicable to me as per the latest
MOHFW guidelines.

I, the primary applicant/passenger, authorise to be contacted by the Ministry of Health and Family Welfare, Government
of India, for the purpose of identification and related checks of my co-passenger(s), if required. In case of any default, the
primary applicant will be liable for punishable offences under the provisions of the relevant Indian Laws. I also agree to
the terms & conditions.

I, the primary applicant, certify that the information filled is correct and true.

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