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  • SR 2206251377273

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    This document contains a self-declaration form for an international arriving passenger named Monika Agrawal from Nepal. The form collects details such as her registration number, date of birth, gender, flight details, passport information, date of arrival, vaccination details, cities visited in the last 14 days, and health conditions. It also notes that she is not taking a connecting domestic flight, has uploaded her vaccination certificate, and is traveling alone to her final destination in Meghalaya, India. By filling out the form, she agrees to follow Ministry of Health guidelines and undertake any required quarantine, monitoring, or testing.

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    Sr 2206251377273

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    This document contains a self-declaration form for an international arriving passenger named Monika Agrawal from Nepal. The form collects details such as her registration number, date of birth, gender, flight details, passport information, date of arrival, vaccination details, cities visited in the last 14 days, and health conditions. It also notes that she is not taking a connecting domestic flight, has uploaded her vaccination certificate, and is traveling alone to her final destination in Meghalaya, India. By filling out the form, she agrees to follow Ministry of Health guidelines and undertake any required quarantine, monitoring, or testing.

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    © All Rights Reserved
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    2 views2 pages

    SR 2206251377273

    Uploaded by

    brkc962h79
    This document contains a self-declaration form for an international arriving passenger named Monika Agrawal from Nepal. The form collects details such as her registration number, date of birth, gender, flight details, passport information, date of arrival, vaccination details, cities visited in the last 14 days, and health conditions. It also notes that she is not taking a connecting domestic flight, has uploaded her vaccination certificate, and is traveling alone to her final destination in Meghalaya, India. By filling out the form, she agrees to follow Ministry of Health guidelines and undertake any required quarantine, monitoring, or testing.

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    © All Rights Reserved
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    Self Declaration form details for international arriving passengers

    Applications are being accepted on behalf of the Ministry of Health and Family Welfare, Government of India

    ___ PASSENGER DETAILS V

    Registration Number Date of Birth


    SR2206251377273 07/11/1985

    Name Gender
    MONIKA AGRAWAL FEMALE

    Flight Number Seat Number


    RA205 24F

    PNR Number Nationality


    NEPAL

    Passport Number Country of Origin


    09732829 NEPAL

    Date of Arrival Domestic Connecting Flight


    25/06/2022

    Are you taking a connecting Domestic flight? Date of RT-PCR Test Taken
    NO -

    RT-PCR Negative Certificate Uploaded Date of Final Dose of Vaccination


    No 27/04/2022

    Vaccination Certificate Uploaded First Airport of Entry


    Yes DELHI AIRPORT

    City of Origin Final Destination - House Number


    KATHMANDU 12

    First Airport of Entry State/Union Territories Final Destination Tehsil


    NEW DELHI

    Final Destination Street/Village Final Destination District/City


    POLICE BAZAAR EAST KHASI HILLS

    Final Destination State/Union Territories Contact Number


    MEGHALAYA +918729962229

    Final Destination Pincode Email ID


    793001 MONICAGARWAL@GMAIL.COM

    Alternate Contact Number Diabetes


    +919863062229 No
    Fever Hypertension
    No No

    Cough Bronchial Asthma


    No No

    Respiratory Distress Cancer


    No No

    Unde Immunosuppresive Therapy


    No

    Post Transplant Patients


    No

    Details of the Cities / Countries visited in last 14 days? Location of Final Vaccination dose
    NEPAL India

    Are you fully vaccinated?


    YES

    How many passengers are travelling with you in the same flight and to the same final destination?
    1

    I/We have agreed to the following terms:

    I agree to the guidelines issued by Ministry of Health & Family Welfare.

    I, the primary applicant, verify that the information filled is correct and agree to be contacted for the co - passenger
    contact tracing. In case of any default, the primary applicant will be liable for punishable offences under the provisions of
    the relevant Indian Laws. I also agree to the terms & conditions.

    I undertake to quarantine/self monitor/take the self paid RTPCR test on arrival as applicable to me as per the latest
    MOHFW guidelines.

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