TRAVEL DECLARATION FORM

(RECORD REQUIRED DUE TO CORONAVIRUS)

All employees who have travelled to and from Mainland China or countries confirmed
infection MUST complete this form.

Name: Department:
 
Home address or address you will be staying
in the next 14 days from date of this
declaration

Handphone Phone Number: Home Number:

   

Please provide the information truthfully and accurately.

Date departed Malaysia:

Date return to Malaysia:

Country and city visited:

Alone or in a group:

Family members staying with you who has

visited Mainland China or countries
confirmed infection:

Friends or relatives from Mainland China or

countries confirmed infection staying with
you this CNY:

Note:
Once you have notified HR, we will call you to discuss return to work. Please do not return to work
without prior discussion with HR. As a precautionary measure, the company may request you to
work from home for up to 14 days by applying hospitalization leave online.

Signature/ date: HR acknowledgement: