11/30/2020 Health & Contact Declaration

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

Self health declaration form

HYD  MAA
Hyderabad - Chennai 01 Dec 2020, 19:40 - 21:00 6E 223 PNR - MPK4UX

RATNAM AV

Mobile No 91 9848022612

Email Id avr24@yahoo.com

Age 61

Destination address Masab Tank

Destination Pin code 500072

COVID Status I am not COVID-19 positive.

I have declared that:

I am not residing in any containment zone.

I am not su ering 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 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.

https://www.goindigo.in/health-and-contact-declaration.html 1/2
11/30/2020 Health & Contact Declaration

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

Self health declaration form

HYD  MAA
Hyderabad - Chennai 01 Dec 2020, 19:40 - 21:00 6E 223 PNR - MPK4UX

BABU GK

Mobile No 91 9849956362

Email Id kumargadi@gmail.com

Age 44

Destination address manikonda

Destination Pin code 500089

COVID Status I am not COVID-19 positive.

I have declared that:

I am not residing in any containment zone.

I am not su ering 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 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.

https://www.goindigo.in/health-and-contact-declaration.html 2/2