02/04/2022 14:08 Turismo de Portugal

The form was submitted. Please print it and have it with you during
the travel.

Passenger Locator Form

Submitted
2022-04-02 13:07:58

The information you provide will assist the Portuguese public health
authorities to trace passengers who may have been exposed to COVID-19.
The information is intended to be held by the Portuguese public health
authorities in accordance with applicable law and to be used only for
public health purposes.
All fields are mandatory. The form can be submitted within 4 days prior to
arrival in Portugal. Once submitted, you will receive a notification that you
should keep with you, digitally or printed, during your trip.

For further information see Decree Law | DRE

Flight Information

Airline
TAP - Portugal Other

Flight number
TP1089

check the flight number on your

boarding pass

Are you a crew member?

No Yes

Seat number
16C

where you actually sat

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Date of arrival Time of arrival

03-04-2022 06:45

Coming from Going to

SPAIN Lisboa

Passenger in transit
Passengers in transit must have a stopover of less than 24 hours

Final destination information

Final destination airport
Outside Mainland Portugal

Date of arrival
03-04-2022

Personal Information

Full name (first name followed by family name(s))

Loïc Visart de Bocarmé

Identification document Number of document

Passport EP654105

Date of birth Gender

30-03-1993 Male

Mobile phone number (please include country code if applicable)

+32 474643172

Email Address
loicvisart@gmail.com

Permanent address (if not Portugal)

Rue Lincoln 43

City and State/Province Country

Bruxelles BELGIUM

ZIP/Postal code
1180

Emergency contact information

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Contact information of the person who will easily reach you in the next 15
days, in case of emergency.
This must NOT be yourself.

Full name
Pierre Visart de Bocarmé

Mobile phone number (please include country code if applicable)

+32 475818440

I understand this form and the Directorate-General of Health, as the

owner of the data, comply with the GDPR and the Portuguese Law
58/2019, from August 8th, and the data is retained for 15 days after the
flight date, after which will be deleted.
Project by
Turismo de Portugal © 2020 - All Rights Reserved

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