12/9/2020 Health & Contact Declaration

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

Self health declaration form

CCU  CCJ
Kolkata - Kozhikode 10 Dec 2020, 07:20 - 14:30 6E 1396E 2297 PNR - JQULXE

Rituraj Paul

Mobile No 91 9051623634

Email Id rituraj.paul@gmail.com

Age 26

Destination address IIM Kozhikode Campus

Destination Pin code 600096

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.

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