Public Health Passenger Locator Form

Thank you for helping us protect your health

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Family Name: YANCE First Name: MICHAEL<JOHN Gender: Male

Date of birth: 1986-06-05 Nationality: Philippines
Passport or ID card number: Are you a resident of
P4462963A Belgium?: No
Mobile phone:
+35699966034
email address: michael.demonet@gmail.com

Arrival date: 2022-04-27

Flight number: IIK5FR

Category: Border residents/workers

Location From To
Malta ( MT ) 2022-04-12 2022-04-27

Street: Woluwe Number: 67 Box: 1200

Country: Belgium State/Province: Brussels Zip/postal code: 1200 City: Lambert

Do you hold any of the following certificates?:

[V] Vaccination 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.