Public Health Passenger Locator Form

Thank you for helping us protect your health

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Family Name: MORA

First Name: LOURDES Gender: Female
GÓMEZ
Date of birth: 2006-09-30 Nationality: Spain
Passport or ID card number: Are you a resident of
18495089F Belgium?: No
Mobile phone: +34621366728
email address: lourdesmoragoo@icloud.com

Arrival date: 2021-12-04

Flight number: Tp644 Seat occupied during the flight: 17F

Location From To
Badajoz ( ES ES431 ) 2021-11-19 2021-12-04

Street: Rue de la fourche Number: 17-19

Country: Belgium State/Province: Bruselas Zip/postal code: 1000 City: Bruselas

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.