Public Health Passenger Locator Form

Thank you for helping us protect your health

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Family Name: Alves Rodrigues First Name: Maximiliano Gender: Male

Date of birth: 1980-10-19 Nationality: Brazil
Passport or ID card number: Are you a resident of
GD490560 Belgium?: No
Mobile phone: +351933550798
email address: maxalves12345@gmail.com

Arrival date: 2022-03-17

Flight number: FR2932 Seat occupied during the flight: 27D

Location From To
Algarve ( PT PT150 ) 2022-03-02 2022-03-16

Street: Rue Carajoly Number: 9

Country: Belgium State/Province: Fleurues Zip/postal code: 6224 City: Charleroi

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.