Self Declaration form details for international arriving passengers

Applications are being accepted on behalf of the Ministry of Health and Family Welfare, Government of India

___ PASSENGER DETAILS ___

Registration Number
SR2301180275875

Name Flight Number

RAGHVENDRA SHRIVASTAVA UK156

Nationality Passport Number

INDIA U9788955

Date of Arrival Country of Departure ( Origin )

18/01/2023 NEPAL

Date of RT-PCR Test Taken RT-PCR Negative Certificate Upload

- NO

First Airport of Entry Final Destination Address

DELHI AIRPORT B-601, MANOKAMNA APARTMENTS,
PLOT NO. 16, SECTOR 18A, DWARKA

Final Destination State/Union Territories Final Destination District/City

DELHI SOUTH WEST

Final Destination Pincode Mobile Number

110078 +919910406152

Email ID Details of the Countries visited in last 14

days?
SHRIRAGHVENDRA@YAHOO.COM NONE

Are you a Transit Passenger? Country of Transit

NO -

Transit Flight Number ( Arriving in India )

-

How many passengers are travelling with you in the same flight and to the same final destination?
0

I/We have agreed to the following terms:

I agree to the guidelines issued by Ministry of Health & Family Welfare.
I undertake to quarantine/self monitor/take the self paid Covid-19 test on arrival as applicable to me as per the latest
MOHFW guidelines.
I, the primary applicant/passenger, authorise to be contacted by the Ministry of Health and Family Welfare, Government
of India, for the purpose of identification and related checks of my co-passenger(s), if required. In case of any default, the
primary applicant will be liable for punishable offences under the provisions of the relevant Indian Laws. I also agree to
the terms & conditions.
I, the primary applicant, certify that the information filled is correct and true.
For latest travel advisory kindly visit the link, https://www.newdelhiairport.in/covid19