REPUBLIC OF THE PHILIPPINES DEPARTMENT OF JUSTICE BUREAU OF IMMIGRATION MAGALLANES DRIVE, INTRAMUROS 1002 MANILA TRAVEL DECLARATION AND ACCEPTANCE OF TERMS AND RISK FORM ‘A. TRAVEL DECLARATION 1 acknowledge that the IATF- EID Resolution 57 s. 2020 dated 21 July 2020 requires the execution of a Deciaration ‘acknowledging the risks involved in travelling, including risks Of delay as a result of COVID-19 pandemic. I declare that I am medically and physically ft to travel abroad as advised by my medical doctor/s. In case of hospitalization or travel disruption abroad, I likewise declare that I have the means to support the expenses therefore. B. TERMS AND CONDITION It Is understood that the Boarding Pass issued by the airline ‘constitutes that the passenger is fully aware of the IATF rules/ regulation; It is understood that the airline crew/ personnel laid safety Precautions measures and health protocols to the passenger; AA travel risk procedure is provided through the Airline check-in process; Al passengers shall undergo risk assessment protocols; It is understood that the passenger comprehend all the terms and ‘condition provided in writing and orally and must demonstrate the ability to understand the current situation; and Passenger shall undergo BI formalities and may be officaded for ‘any other lavful causes. ‘Signature over printed name | declare that the above information is true and | accept that there is a risk when undertaking this travel. | have read and accepied all the terms and conditions provided above, and also understood the briefing, demonstration and instruction given to me in writing and orally at the Pre- Check in Screening Date signed NAME (As shown in the passport): Dos: ‘Address in the Philippines: ‘Address Abroad: Contact no: Email address: Contact Person in case of Emergency: Brief Explanation why need to travel: (Is essential?) ‘Airine Information (to be filed out by Airline staff7 crew): Destination Country: Flight no: Please indicate any information that shall assist the BI in thelr admission process (If any): Name of Airline Personnel Date: "Note: Passengor shal submit this Form fo ihe immigration Officer during Bl departure formalies