Please carry the print of this page on the day of Travel

Self health declaration form

CNNBOM
Kannur (T1) - Mumbai 22 Oct 2023, 16:15 - 18:05 6E 5172 PNR - R34P3E
BOMVNS
Kannur (T1) - Mumbai 22 Oct 2023, 20:20 - 22:40 6E 2125 PNR - R34P3E

Juan Ramon Anaya Moreno

Mobile No 91 8867252587

Email Id jr.anaya@usa.net

Destination Addres Hotel Runnaway Inn

Destination Pincode 221006

COVID Status I am not COVID-19 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 COVID-19 positive in the last two months.
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.
Travel Advisory - Safety during COVID-19
We seek your kind assistance to safeguard your well-being. as well as that of
your fellow passengers and our crew on board our flights, by following the
guidelines set out below:
• lndiGo shall provide a complimentary safety kit (three layered surgical masks, a
face shield, and a sanitizer) to all customers at the boarding gate.
• Customers seated in middle seats will also be provided additional protective
equipment in the form of a wrap-around gown.
• All customers should wear a mask, face shield, gown (if applicable) and sanitize
their hands before proceeding to the boarding gate.
• Customers must wear a face mask covering their nose and mouth, throughout
their journey with lndiGo. The mask may be removed while eating and drinking.
• Please maintain appropriate social distancing while boarding and de-boarding the
aircraft.
• Kindly adhere to all the announcements and other directives issued by our ground
sta" and/or crew at all points of time during your journey.
• Customers are also requested to familiarise themselves with the guidelines for air
passengers published by the Indian Ministry of Civil Aviation on the following link:
https-
J/www.civilaviation.gov.in/sites/defaulUfiles/Guidelines_for_Air_Passengers_21May.pdf
• Caution: Customers are advised to strictly follow all COVID-19 protocols.
Failure to comply with these guidelines and the directions of our ground sta!
and/or crew may attract penal action against the concerned individual.