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    This document provides a health declaration and screening summary for an individual traveling from the United Kingdom to Nigeria. It includes the traveler's personal details like name, date of birth, passport and phone numbers. It also lists the countries visited in the last 21 days, destination and duration of stay in Nigeria. Emergency contact details in Nigeria and health details like symptoms, sick contacts, medications in the last few days are also provided. The document confirms the traveler is fully vaccinated and signs off with their arrival date.

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    This document provides a health declaration and screening summary for an individual traveling from the United Kingdom to Nigeria. It includes the traveler's personal details like name, date of birth, passport and phone numbers. It also lists the countries visited in the last 21 days, destination and duration of stay in Nigeria. Emergency contact details in Nigeria and health details like symptoms, sick contacts, medications in the last few days are also provided. The document confirms the traveler is fully vaccinated and signs off with their arrival date.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views1 page

    Result

    Uploaded by

    Paul Foster
    This document provides a health declaration and screening summary for an individual traveling from the United Kingdom to Nigeria. It includes the traveler's personal details like name, date of birth, passport and phone numbers. It also lists the countries visited in the last 21 days, destination and duration of stay in Nigeria. Emergency contact details in Nigeria and health details like symptoms, sick contacts, medications in the last few days are also provided. The document confirms the traveler is fully vaccinated and signs off with their arrival date.

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    of 1

    YOUR HEALTH DECLARATION & SCREENING SUMMARY

    Fully Vaccinated

    PERMIT TO
    TRAVEL

    Phone Number Passport Number


    07947132108 125149636

    Gender Nationality
    Male British Indian Ocean Territory

    Date of Birth Country of Residence


    24/06/1964 United Kingdom

    Travel
    Details

    Flight Number Departure Airport Arrival Airport


    BA83 London Heathrow Airport FCT
    Seat Number

    COUNTRIES VISITED
    IN THE LAST 21 DAYS

    United Kingdom,

    DESTINATION IN NIGERIA
    FOR THE LAST 21 DAYS

    Address 1 City, State Duration of stay


    63 Guildford Road Abuja, FCT 24 day(s)

    EMERGENCY CONTACT OR NEXT OF KIN


    IN NIGERIA

    Name Phone Number Address


    Rebecca Anumba 08033461150 40b ubiaja crescent

    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
    Foster Paul 11/11/2022 Fully Vaccinated

    Fully Vaccinated (NO PAYMENT)

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