Please carry the print of this page on the day of Travel IndiGo Self health declaration form IXE>JDH Mangaluru Jodhpur - 26 eb 2022, 22:05- 10:10 » 6E72126E 6213 « PNR-TIKGNF AmruthaV Mobile No 1 gooascene3 fais rani383200@grailcom Destination address Kosta Destination Pn code s7s006 comp satus {am not COVD-19 posta. "have declared that: + Lam not residing in any containment zone + Lam not suffering feom any fever, cough, oF any resplratory distress. + am notunder quarantine. + ILever develop any of the above mentioned symptoms willimmediately contact the concerned health authorities + Ihave not tested COVID-19 postive in the ast three weeks + Lam elite to travel as per the extant norms. + wil make my mobile number’ contact details available ta IniGe, whenever required by them, + understand that i undertake te airjourney without meeting the eligiilty cteia, would be Hable to penal action + Iwill adhere tothe heath protocol prescribed by the destination stat union territory.