……. AFSB,……………….

SELF CERTIFIED UNDERTAKING FOR COVID-19

Name…………………...AFCAT Roll No………………..Batch no. AFCAT……………..DOB……..

Mode of Travel: Air/ Rail/ Bus/ Pvt Car Flt No/ Train No/ Public or Own Transport No.
Start Date of Travel :………………………. Arrival date at … AFSB :……………………..
Place of Origin of Journey with address Place where journey was halted:

1…………………….....2……………………….

3………………………..4……………………

Mobile Number………………………………. All places visited during last 21 days including any
international travel:
1………………………..2……………………….

Medical History during last 21 days: Any visit to COVID-19 Hospital or interaction with
COVID-19 patient : Yes / No
1. Cough : Yes / No
2. Cold : Yes / No
3. Fever : Yes / No
4. Difficulty in breathing : Yes / No

I hereby undertake the following in the event of being detected with any visible symptoms
of COVID-19 (Fever, Cough, Cold, Breathing Problem, etc) at any stage post-reporting at the
AFSB:-

(a) That I will not suppress any symptoms or hide relevant info.
(b) That I will be routed back with immediate effect if detected with symptoms during
arrival/ reception at the Board.
(c) That I will voluntarily withdraw my candidature if detected with symptoms during
Stage-II stay at AFSB.
(d) That I will accept the decision of Board authorities as final and binding.
(e) That I will not seek change of date or claim TA in such cases.
(f) That I will not take legal recourse against the Board's decision.

---------------------------------
(Signature of Candidate/ Parent/ Legal Guardian)

** Note:- In case the Candidate is below the age of 18 years, the undertaking should be
signed by the Parent/ Legal Guardian.
 ADVISORY FOR COVID-19

1. Do not travel and report to AFSB, if you have any of the following:-

(a) Fever, cough, cold, breathing problem etc.

(b) In case of recent international travel history or travel to any COVID hot spots or a
resident of any COVID hotspot.

2. Please carry adequate quantity of personal protective gear like mask, face shield, gloves
and hand sanitizer for your duration of testing.

3. You have to mandatorily download AROGYA SETU app in your personal mobile at
least 14 days before your date of reporting / receipt of call letter, the safe status will be checked
at the time of reception.

4. Please strictly abide by all DO'S and DONT'S of COVID-19 advisories issued by Govt of
India. Adhere to all the social distancing norms while travelling.

I have adhered to all the advisories on COVID-19. The information provided by me in the
undertaking / self-certification is correct. If I am found with any symptom(s) of corona virus, I
understand that I may be routed back / quarantined / admitted in local hospitals as per Govt rules.

Date :……………… Sign of Candidate