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  • Health & Contact Declaration

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    Ankit Jain
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    This is a self-health declaration form for travel from Delhi to Goa on August 6th, 2020. The form includes the traveler's name, mobile number, email, age, destination address and pin code. It requires the traveler to declare that they are not residing in a containment zone, experiencing any COVID-19 symptoms, under quarantine, or tested positive in the last 3 weeks. It also says the traveler will make their contact details available and follow health protocols at their destination.

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    This is a self-health declaration form for travel from Delhi to Goa on August 6th, 2020. The form includes the traveler's name, mobile number, email, age, destination address and pin code. It requires the traveler to declare that they are not residing in a containment zone, experiencing any COVID-19 symptoms, under quarantine, or tested positive in the last 3 weeks. It also says the traveler will make their contact details available and follow health protocols at their destination.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    7 views1 page

    Health & Contact Declaration

    Uploaded by

    Ankit Jain
    This is a self-health declaration form for travel from Delhi to Goa on August 6th, 2020. The form includes the traveler's name, mobile number, email, age, destination address and pin code. It requires the traveler to declare that they are not residing in a containment zone, experiencing any COVID-19 symptoms, under quarantine, or tested positive in the last 3 weeks. It also says the traveler will make their contact details available and follow health protocols at their destination.

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    © All Rights Reserved
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    Please carry the print of this page on the day of Travel

    Self health declaration form


    DEL  GOI
    Delhi(T3) - Goa 06 Aug 2020, 11:40 - 14:30 6E 367 PNR - AQUSXB

    Rahul Malik

    Mobile No 91 8587847292

    Email Id skybluetravel@gmail.com

    Age 29

    Destination address Goa

    Destination Pin code 403110

    I have declared that:

    I am not residing in any containment zone.

    I am not su ering from any fever, cough, or any respiratory distress.

    I am not under quarantine.

    If I ever develop any of the above mentioned symptoms I will immediately contact the concerned health authorities.

    I have not tested COVID-19 positive in the last three weeks.

    I am eligible to travel as per the extant norms.

    I will make my mobile number/ contact details available to IndiGo, whenever required by them.

    I understand that if I undertake the air journey without meeting the eligibility criteria, I would be liable to penal action.

    I will adhere to the health protocol prescribed by the destination state/ union territory.

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