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  • Result QR Entry Nigeria

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    Yohemir Marin
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    This document provides a health declaration and screening summary for a traveler arriving in Nigeria from Venezuela. It includes the traveler's personal details like name, date of birth, passport and phone numbers. It lists the countries visited in the last 21 days as Venezuela. The destination in Nigeria is Imo state for 120 days staying at an address in Ibigwe field. An emergency contact is provided. Health details section is blank. The traveler is noted as fully vaccinated and their arrival date is listed as September 27, 2022.

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    Result QR entry Nigeria

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    This document provides a health declaration and screening summary for a traveler arriving in Nigeria from Venezuela. It includes the traveler's personal details like name, date of birth, passport and phone numbers. It lists the countries visited in the last 21 days as Venezuela. The destination in Nigeria is Imo state for 120 days staying at an address in Ibigwe field. An emergency contact is provided. Health details section is blank. The traveler is noted as fully vaccinated and their arrival date is listed as September 27, 2022.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    5 views1 page

    Result QR Entry Nigeria

    Uploaded by

    Yohemir Marin
    This document provides a health declaration and screening summary for a traveler arriving in Nigeria from Venezuela. It includes the traveler's personal details like name, date of birth, passport and phone numbers. It lists the countries visited in the last 21 days as Venezuela. The destination in Nigeria is Imo state for 120 days staying at an address in Ibigwe field. An emergency contact is provided. Health details section is blank. The traveler is noted as fully vaccinated and their arrival date is listed as September 27, 2022.

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    © All Rights Reserved
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    of 1

    YOUR HEALTH DECLARATION & SCREENING SUMMARY

    Fully Vaccinated

    PERMIT TO
    TRAVEL

    Phone Number Passport Number


    08073482630 170607926

    Gender Nationality
    Male Venezuela

    Date of Birth Country of Residence


    21/10/1975 Venezuela

    Travel
    Details

    Flight Number Departure Airport Arrival Airport


    TK 625 Sim?n Bol?var International Airport Lagos
    Seat Number

    COUNTRIES VISITED
    IN THE LAST 21 DAYS

    Venezuela,

    DESTINATION IN NIGERIA
    FOR THE LAST 21 DAYS

    Address 1 City, State Duration of stay


    Ibigwe field Ohaji LGA Imo Imo, Imo 120 day(s)

    EMERGENCY CONTACT OR NEXT OF KIN


    IN NIGERIA

    Name Phone Number Address


    Ohia Emmanuel Ozioma 08037652998 Imo state

    HEALTH DETAILS

    SYMPTOMS SICK PERSON CONTACT MEDICATION


    IN THE LAST 21 DAYS IN THE LAST 21 DAYS IN THE LAST 24 HOURS

    LAB

    Passenger Name Arrival Date Vaccination Status


    Signature
    MARIN MEDINA YOHEMIR 27/09/2022 Fully Vaccinated

    Fully Vaccinated (NO PAYMENT)

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