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SelfDeclare IL3CQY 0 571306774 230527 172844
SelfDeclare IL3CQY 0 571306774 230527 172844
carry the print of this page on the day of Travel
Self health declaration form
IXC BOM
Chandigarh Mumbai (T1) . 28 May 2023 17:00 . 6E 5234 . PNR IL3CQY
NEHA SANDEEP KHEDEKAR
Mobile no 9189760476
Email Id sandeepsan570@gmail.com
Destination address 1234
Destination Pin code 1234
COVID Status I am not COVID19 positive.
I have declared that:
I am not residing in any containment zone.
I am not suffering from any fever, cough, or any respiratory distress.
I am not under quarantine.
If I ever develop any of the above mentioned symptoms I will immediately contact the concerned health
authorities.
I have not tested COVID19 positive in the last three weeks.
I am eligible to travel as per the extant norms.
I will make my mobile number/ contact details available to IndiGo, whenever required by them.
I understand that if I undertake the air journey without meeting the eligibility criteria, I would be liable to
penal action.
I will adhere to the health protocol prescribed by the destination state/ union territory.
Please carry the print of this page on the day of Travel