Public Health Passenger Locator Form

Thank you for helping us protect your health

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Family Name: SIMIOANA First Name: M?D?LIN-VIOREL Gender: Male

Date of birth: 1993-10-04 Nationality: Romania
Passport or ID card number: Are you a resident of
1931004394467 Belgium?: No
Mobile phone:
+40721394754
email address: simioanamadalin@gmail.com

Arrival date: 2022-04-24

Flight number: W63081

Location From To
Bucure?ti – Ilfov ( RO RO32 ) 2022-04-09 2022-04-24

Street: Waterloosesteenweg Number: 212

Country: Belgium Zip/postal code: 1640 City: Waterloo

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.