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    Andre Haughton
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    This document contains a health declaration and screening summary for a traveler named Haughton Andre. It provides key details about his passport, nationality, date of birth, countries visited in the last 21 days, destination and duration of stay in Nigeria, emergency contact, health symptoms and contacts in the last 21 days, and medications in the last 24 hours. It confirms he is fully vaccinated and lists his arrival date and vaccination status.

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    This document contains a health declaration and screening summary for a traveler named Haughton Andre. It provides key details about his passport, nationality, date of birth, countries visited in the last 21 days, destination and duration of stay in Nigeria, emergency contact, health symptoms and contacts in the last 21 days, and medications in the last 24 hours. It confirms he is fully vaccinated and lists his arrival date and vaccination status.

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    2 views1 page

    Result 2

    Uploaded by

    Andre Haughton
    This document contains a health declaration and screening summary for a traveler named Haughton Andre. It provides key details about his passport, nationality, date of birth, countries visited in the last 21 days, destination and duration of stay in Nigeria, emergency contact, health symptoms and contacts in the last 21 days, and medications in the last 24 hours. It confirms he is fully vaccinated and lists his arrival date and vaccination status.

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    of 1

    YOUR HEALTH DECLARATION & SCREENING SUMMARY

    Fully Vaccinated

    PERMIT TO
    TRAVEL

    Phone Number Passport Number


    09157505037 M00170587

    Gender Nationality
    Male South Africa

    Date of Birth Country of Residence


    28/04/1988 South Africa

    Travel
    Details

    Flight Number Departure Airport Arrival Airport


    SA60 O.R. Tambo International Airport Lagos
    Seat Number

    COUNTRIES VISITED
    IN THE LAST 21 DAYS

    South Africa,

    DESTINATION IN NIGERIA
    FOR THE LAST 21 DAYS

    Address 1 City, State Duration of stay


    33 Creek Road Apapa Lagos, Lagos 60 day(s)

    EMERGENCY CONTACT OR NEXT OF KIN


    IN NIGERIA

    Name Phone Number Address


    African Diving Services 08092796832 33 Creek Road Apapa

    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
    Haughton Andre 05/08/2022 Fully Vaccinated

    Fully Vaccinated (NO PAYMENT)

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