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Self health declaration form


IXC BLR
Chandigarh ­ Bengaluru (T1) . 02 Oct 2023 08:10 . 6E 6634 . PNR ­ EPBQPS

NIKHILESH SHARMA

Mobile no 7814163215

Email Id nikhileshsharma30@gmail.com

Destination address Course5 Intelligence Ltd

Destination Pin code 560103

COVID Status I am not COVID­19 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 COVID­19 positive in the last three weeks.
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.

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

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