Declaration Form Under the Egyptian Quarantine law and the International Health Regulations (IHR 2005), this Public Health Declaration Form is a mandatory document and aims to protect your health. Your information will help public health officers contact you if you were exposed to a communicable disease. It is important to fill out this form completely and accurately. |, the undersigned, hereby confirm that all the information | provide below is correct and that | have neither been recently diagnosed with COVID-19, nor did |, knowingly, have had close contact with any person suspected or tested positive for COVID-19, nor have | not suffered from any symptoms during the past 14 days. Full Nam Nationality: Date of Birth: Day Month Year Passport Number Profession: Airline Name: Flight Number: Arriving from Address in Egypt: Telephone/Mobile Number: E-mail Address: Do you have symptoms such as high fever, cough, sore throat and shortness of breath? Yes ([_} No cy In the last 14 days, have you had contact with someone who tested with COVID-19? Yes No Which country / countries have you visited (full route) during the past 14 days? Should | experience any symptoms of COVID-19 during my stay in Egypt, | will immediately report the incident to the hotel management and doctor and seek the necessary medical assistance, or call 105. Should | change the above mentioned address or phone number during my stay in Egypt | will call 105 to give the new information. In case | violate the above, the Egyptian Government shall not be subject to any liability, whatsoever, if | show evidence of positive testing for COVID-19 during the 14 days after departure. Failure to submit this declaration will result in an illegal entry to the country. I hereby confirm that | have read and understood all of the above. Signature: Date:coawall fil Fahy ga We Aalall Lace Milby Of peal) canal! spall Usilly IHR 2005 Asal! dacell qislll ange aI AY Cateye BAS 1) Gh Leash gles Libel) Rana ily bales 20L5 Gigs ¢ Ghee Gls ll Gag LL j Bagg Jad aU 03a ea pgall Ga es Aue salad! Ly sll Gaye De Get oe al aly dane Vga a lah gue oh ile oll adgall Uf Wag V8 DS Gabel Gl ge piel aly COVID-19 4 ylSs! Ss) 4p date Gass sl Liu! ly COVID-19 Agel Aalstly pal Auta FASS! aya Sail gb Gace — Gla gd bia! — las — ayLpall days EU) Be Lace Gale! isl Ge il dt Co YC)D “ {fag VE 58) GCOVID-19 Gs hens Gadd sh JL ge cus Ja C Y = Aula age VE IDS YUH cad ll Spall Le eth adel yySka) aN gy I Glgiad ats Gud 13) I COVID-19 apiad Gy SI) Gay Gabel ch syetll dla Ga N88 phy ucla jue gd sali H Gus le JS cagdy CD ga 1a ngs asi ees ye) oes o+ gaa