Passenger Health Undertaking

Dear KAUSHIKMR BASU

Greetings From Air India !

Your Form for Passenger Health Undertaking submitted successfully as per following details :

No of Mobile Date of Health Submitted

Email ID Name Address Pincode Flight No PNR Sector
Passenger No Travel Status By
Self or/and on
Barasat behalf of
tcwm60@gm KAUSHIKMR
3 Kolkata West 700124 8697735286 535 J3J0Z 26-10-2020 DELCCU Yes group
ail.com BASU
Bengal travelling
together

The passenger has given a declaration to the following effect :

i) I/We am/are not residing in any containment zone.

ii) I/We am/are not suffering from any fever/cough/any respiratory distress.
iii) I/We am/are not under quarantine.
Or

I/We am/are under quarantine, but having a negative RT-PCR test report, for which test was conducted within 96
hours prior to undertaking the journey from abroad.
iv) if I/We develop any of the above-mentioned symptoms i shall contact the concerned health authorities
immediately.
v) I/We have not tested COVID-19 positive in the last three weeks (COVID-19 recovered persons fulfilling this
condition will be allowed to travel upon showing a COVID-19 recovered/discharged certificate from any institution
dealing with COVID-19 subjects)
vi) I/We am/are eligible to travel as per the extant norms.
vii) I/We will make my mobile number / contact details available to the airlines whenever required by them.
viii) I/We understand that if I/We undertake the air journey without meeting the eligibility criteria, I/We will be
liable to penal action.
ix) I/We undertake to adhere to the health protocol prescribed by the destination state / UT.