NATIONAL CRISIS PREPAREDNESS AND RESPONSE CENTRE (CPRO) MINISTRY OF HEALTH MALAYSIA Date of etterissued > 30/03/2022 Dear Sir/Madam, REF: APPROVAL FOR HOME QUARANTINE The above matter refers. Please be informed that your request for home quarantine has been APPROVED and therefore allowed to perform the mandatory quarantine at the stated address subject to compliance to all set Standard Operating Procedures (SOPs), rules and regulations by the Goverment af Malaysia and Ministry of Health. This approval is based on the travel details, arrival date, and residential address including criteria declared in Appendix A. Applicant's detall: HQA Ref. No. HSO10032272060682 Name | LE THI THANH THUY Passport No. /NRIG/ : C7979436 Address NO 8, JALAN 4/35, SEKSYEN 4, 46050 PETALING JAYA, 46050, PETALING, SELANGOR. ‘Contact No. + 01162080116 Arrival Date : 30/03/2022 Please refer to Appendix 8 for the Standard Operating Procedures (SOPs), rules and regulations. Failure to comply with the Home Surveillance Order (HSO} is an offence and chargeable in court. For travellers arriving from the high-risk countries, please refer to Appendix C to register yourself and your family. ‘Any enquiries including removal of wrist band kindly contact our staff at JKN SELANGOR at +60351257366 / +60351237867 or e-mail to: cpre_sel@moh.gov.my for further information and laritication if required. For more information on contact numbers or issues related to COVID19, you can visit htips://covid! 8.moh.gov.my/hotline. ‘Thank you. Home Surveillance Order Committee NATIONAL CRISIS PREPAREDNESS AND RESPONSE CENTRE (CPRC) MINISTRY OF HEALTH MALAYSIA The approval is only valid for one month from the date of approval and for single entry This is a computer generated document. No signature is required.‘Appendix B This permission is granted subject to compliance to all set Standard Operating Procedures (SOPS), fules and regulations by the Government of Malaysia and Ministry of Health: 1. Todo pre-departure RT-PCR COVID-19 swab test two (2) days before departure with a negative COVID-19 resutt (this is requited for al nationalities from all age group); Download and register My Sejahtera application before arrival; To scan MySejahtera QR code and updates information upon arrival. The home, address in MySejahiera must correspond to the address on the approval given; RT-PCR COVID-19 test will be conducted on arrival; Uneventtul health sereening outcome at the entry point; Home Surveillance Order (HSO) and wristband will be given on arrival; Wear a face mask and always practice physical distancing and comply with SOPs during your quarantine period: Use MySejantera application fo monitor COVID-19 symptoms and if you have symptoms please seek treatment at the nearby health facility; ‘You must always isolate yourself at the stated address during the quarantine period; Visitors ate not allowed to visit you during the quarantine period Travellers from United Kingdom need to do daily RTK-Ag self-test during quarantine and report the test result on MySejahtera. 12, The repeat swab test and Release Order are based on the GOVID-19 vaccination status as mentioned below: 12.1 Fully vaccinated adults with booster or adolescents travelling alone *'To do RT-PCR on Day 4 or supervised RTK-Ag on Day 5; + To get Release Order on Day 5 if RT-PCR on Day 4 is negative or it supervised RTK-Ag test on Day 5 is negative al the nearest District Health Office. 12.2 Fully vaccinated without booster * To do RT-PCR on Day 5 or supervised RTK-Ag on Day 7: + To get Release Order on Day 7 if RT-PCR on Day 5 is negative or it supervised RTK-Ag test on Day 7 is negative at the nearest District Health Office, 12.3 Partially vaccinated or unvaccinated, * To do RT-POR on Day @ or supervised RTK-Ag on Day 10; + To get Release Order on Day 10 if RT-PCR on Day 6 is negative or if ‘supervised RTK-Ag test on Day 10is negative at the nearest District Health Office. © 2 Nome on BEAppendix A DECLARATION HOUSE CONDITION BY PUS Address: NO 8, JALAN 4/35, SEKSYEN 4, 46050 PETALING JAYA, 46050, PETALING, SELANGOR Please state tem the number ts The number of people who live in the house 1 2. _ [Number of occupants more than 60 years old - please specify their age accordingly 0 3. | The number of occupants under the age of 12 years old (under age) 0 please specify their age accordingly ‘4. |The number of occupants suffering from a comorbid condition or any 0 5,_| The number of pregnant women in the house 0 6. | The number of rooms in the house. 6 Lee eee ee ee) et 7._ | The number of bathroomsfoilets 3 8. The number of bathrooms/toilets that are connected to the room (attached bathroom) a “It is important to note that applicants /PUS are required to state the number of people residing in the house prior to applicants /PUS arrival. Please note that applicants /PUS should not be part of the total number of people residing the house. Please indicate "none" if the house is unoccupied when you arrive. “Any false information provided is an offence under Section 22 (d) of the Prevention and Control of Infectious Diseases Act, 1988 [Act 342], and if convicted, is punishable under Section 24 of the same Act. If applicant is found to provide false information, approval will be automatically revoked.Appendix C Travellers arriving from the following counties (as listed below). please register your family and self for the Digital Tracker wrist band at our website htips:/ireg-hqm.quickmed. care/register OR scan the QR code before arrival to Malaysia. Your co-operation is highly appreciated, List of Countries: AUSTRALIA ESWATINI BOTSWANA MALAWI CANADA NAMIBIA DENMARK NIGERIA FRANCE NORWAY INDIA SAUDI ARABIA LESOTHO SOUTH AFRICA MOZAMBIQUE USA UNITED KINGDOM ZIMBABWE “Or any countries categorized as high-risk countries by the Government of Malaysia