Public Health Passenger Locator Form

Thank you for helping us protect your health

43fc5ec9-4b4a-416c-84aa-05d077856021

Family Name: NTANGU-

First Name: ANNY Gender: Female
LUYYEYE
Date of birth: 1979-12-23 Nationality: Canada
Passport or ID card number: Are you a resident of
AD761514 Belgium?: No
Mobile phone: +243893968447
email address: lumekagroupsa@gmail.com

Arrival date: 2022-02-12

Flight number: sn358 Seat occupied during the flight: 12b

Location From To
Congo (DROC) ( CD ) 2022-02-11 2022-02-12

Street: saint denis Number: 15

Country: Belgium Zip/postal code: 1000 City: liege

Do you hold any of the following certificates?:

[V] Vaccination certificate

[V] Negative test certificate

Connecting flight (departing from Brussels): No

I hereby declare that above-mentioned information has been filled in correctly.: [v]

You can modify the PLF up to one day before your arrival in Belgium. Click here to modify your PLF.