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PLC Form: Flight Information
PLC Form: Flight Information
FLIGHT INFORMATION:
Airline name Flight number Seat number Date of arrival
AVIANCA AV78 2022-02-12
PERSONAL INFORMATION:
Last (Family) Name First (Given) Name DATE OF BIRTH Your Sex
ROMERO CARLOS 1998-03-12 MALE
EMERGENCY CONTACT:
Name Phone number
LIDA MARTINEZ +57 320 3451358
HEALTH INFORMATION:
HAVE YOU TRAVELED FOR THE LAST 14 DAYS? NO
HAVE YOU BEEN IN CONTACT WITH A CONFIRMED CASE OF COVID-19? NO
PCR TEST:
Date Type Result
2022-02-10 THROAT AND NASAL SWAB NEGATIVE
INSURANCE INFORMATION:
COUNTRY OF RESIDENT CO
EXEMPTED YES
REASON NOT_YET_APPLICABLE