PM

You have successfully submitted an Electronic Health Declaration to the Immigration & Checkpoints Authority.
This acknowledgement message will also be sent to the email address you have provided.

You may choose to download or print a copy of this acknowledgement.

Providing false health and travel declarations is an offence under Section 64(b) of Singapore's Infectious Diseases
Act. The penalty for providing false or misleading information is a fine of up to S$10,000 and/or imprisonment of
up to 6 months. For subsequent offence(s), the penalty is a fine up to S$20,000 and/or imprisonment of up to 12
months.

You are reminded that it is your responsibility to update and resubmit your declarations prior to your arrival in
Singapore if you had contact with a COVID-19 case, and/or if there is any change in your health status and/or
travel history.

Transaction Date: 26/03/2022 03:03 PM (Singapore Time)

Electronic Health Declaration

Personal Information

NRIC/FIN Email Address

*****012X DANIAL.PADMANATHAN@CIS.EDU.SG
Mobile Number
+65 83157718

Trip Information

Date of Arrival to Singapore

28/03/2022
Mode of Travel
LAND
Type of Accommodation in Singapore
RESIDENTIAL
Street Name Postal Code Block Number
WOODLANDS DRIVE 16 731574 574A
Building Name Unit Number Floor Number
HDB 728 09

Health Declaration

Please indicate all countries/regions that you have been in (including the
country/region of embarkation) or travelled to, (excluding transit and stopover for
air travel only) in the last 7 days prior to your arrival in Singapore.

MALAYSIA

Did you start to have any of the following symptoms in the last 7 days: fever, NO
cough, runny nose, sore throat, loss of sense of smell or shortness of breath?

Are you diagnosed or suspected to have COVID-19 infection in the past 90 days? NO

Do you have an overseas digital vaccination certificate? N/A

If you are required to take COVID-19 Pre-Departure Test (PDT) under the current N/A
requirements for entry into Singapore, you may scan/upload the QR code on the
digital PDT result (if available) here. Please refer to https://safetravel.ica.gov.sg/
shn-and-swab-summary for latest requirements.