12/4/2020 Health & Contact Declaration

Please carry the print of this page on the day of Travel

Self health declaration form

IXC  COK
Chandigarh - Kochi(T1) 05 Dec 2020, 15:55 - 22:15 6E 6126E 832 PNR - YL9IJJ

Ajith John Thomas

Mobile No 91 9645962616

Email Id ajith0mvk@gmail.com

Age 34

Destination address Poothiottu (H), Mattom North, Mavelikkara, Alappu

Destination Pin code 690103

COVID Status I am not COVID-19 positive.

I have declared that:

I am not residing in any containment zone.

I am not su ering from any fever, cough, or any respiratory distress.

I am not under quarantine.

If I ever develop any of the above mentioned symptoms I will immediately contact the concerned health authorities.

I have not tested COVID-19 positive in the last three weeks.

I am eligible to travel as per the extant norms.

I will make my mobile number/ contact details available to IndiGo, whenever required by them.

I understand that if I undertake the air journey without meeting the eligibility criteria, I would be liable to penal action.

I will adhere to the health protocol prescribed by the destination state/ union territory.

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