GENERAL DECLARATION

(Outward/Inward)
Operator: VIETNAM AIRLINES (SKY TEAM MEMBER)
Marks of Nationality and Registration: VNA613 Flight No: VN 5631 Date: 20Jun2021
Departure from: HO CHI MINH CITY, VIET NAM Arrival at: JAKARTA SOEKARNO-HATTA APT, INDONESIA

FLIGHT ROUTING & TOTAL NUMBER OF CREW

PLACE RANK NAME STAFF PASSPORT PASSPORT DOB NAT GENDER NUMBER OF
NUMBER NO EXPIRY PASSENGERS ON
THIS STAGE
Operating _________________
SGN CAPT NGUYEN KHANH THANH 3 0293 C4450963 05Jan2028 24Mar1980 VIET NAM M
CGK Departure place
SGN FO TRINH VU TUNG ANH 20 4229 C9171530 22Jun2030 19Nov1988 VIET NAM M SGN
CGK Embarking
SGN B NGUYEN NGOC DIEP 16 4225 C9696498 18Mar2031 04Dec1975 F
CGK
Through on
SGN Y TRAN NGUYEN UYEN NHI 19 5351 C4177996 14Nov2027 04Dec1992 F same flight
CGK

Arrival place
CGK
Disembarking

Through on
same flight

DECLARATION OF HEALTH FOR OFFICIAL USE ONLY

Name and seat number or function of persons on board with illnesses other than airsickness or the
effects of accidents, who may be suffering from communicable disease ( a fever - temperature
38°C/100° F or greater - associated with one or more of the following signs or symptoms, e.g
appearing obviously unwell; persistent coughing; impaired breathing; persistent diarrhoea; persistent
vomiting; skin rash; bruising or bleeding without previous injury; or confusion of recent onset, increases
the likelihood that the person is suffering a cummunicable disease) as well as such cases of illness
disembarked during a previous stop.

Details of each disinsecting of sanitary treatment (place, date, time, method) during the flight. If no
disinsecting has been carried out during the flight give details of most recent disinsecting.

______________________________________
Signed if required, with time and date
Crew member concerned
I declare that all statements and particulars contained in this General Declaration and in any supplementary forms requires to be presented
with this General Declaration are complete, exact and true to the best of my knowledge and that all through passengers will continue / have
continued on the flight.

Signature: _____________________________________________
Authorised Agent of Pilot-in-command