COVID-19 Test-And-Go Undertaking

I, Mr./Ms./Dasho/………….. (Title) SUDISTA KUMAR DAS...................................... (Name)

Holding (CID/ Passport / Work permit number/Trading card license holder) Z 6356385
…………………….……………………………………………………………………………

from……… Gurgaon.….…….(Village)…Delhi…….….(Gewog)….. Delhi…………... (Dzongkhag)

OR working agency/local point of contact (for non-Bhutanese)…WAPCOS Limited PHEP-II,
Bjimthangkha, Wangdue Phoadrang Dzongkhag / Arun Kumar, 17283518..........................
agree to the following under the COVID- 19.

“Test-and-Go” protocol:

1. Undertake RT-PCR test at the point of entry upon arrival and provide proof of vaccination
(unless you are below 5 years old) or evidence of COVID-19 infection in the last six
months. If these conditions are not fulfilled, an individual shall undergo 5- day home or
facility quarantine.
2. Observe the mandatory stay home/hotel for 24 hours or until negative RT-PCR test is
received.
3. Self-isolate for five days at home/hotel if the RT-PCT test is positive.
4. Make arrangements to travel by dedicated vehicle to the place of stay (home/hotel) that
does not entail an overnight halt without stopping in public places, entering
shops/restaurants or coming in contact with other people.
5. Ensure that family/household members’ movement will be restricted during the
mandatory 24-hours stay and five days isolation period (if test is positive).
6. Be fully responsible for any breach of these protocol by me or my family/household
members and to be dealt as per the existing laws of the country.
7. If staying in a hotel, obtain a confirmation from the hotel that the “Test-and-Go” protocol
in terms of 24 hours mandatory stay and five days isolation (if test is positive) has been
agreed to by the hotel in keeping with COVID-19 safety protocol.

Additional details are attached.

Signature of applicant:
Name: Sukdista Kumar Das
Residential Address: Delhi
Phone no: +975-17283518
Emergency Contact Person and number: +975-17283518

Page 1 of 2
 COVID-19 Test-and-Go
(Additional details)

1. Date of arrival (dd/mm/yy): 21.09.2022

Port of embarkation: Delhi, India

2. If you are traveling with family please provide the following details (separate

undertaking not required):

a) Name and contact number:

b) Name and contact number:

c) Name and contact number:

d) Name and contact number:

3. Place of stay/residence (location/name): PHPA-I, Project Colony Guest House, Bjimthangkha.

4. Number of household members: Alone

5. Details of person who will pick you up at the point of entry:

a) Name: Ugyen Tshewang

b) Contact number: +97517462096
c) Vehicle number:BG-1-A-3294 ( Innova)
d) Driver license number: PD-10692

Signature: Name:

Page 2 of 2
 COVID-19 Test-And-Go Undertaking

I, Mr./Ms./Dasho/………….. (Title) AMIT RANJAN ................................................... (Name)

Holding (CID/ Voter ID /Work permit number/Trading card license holder)

UJE1842276…………….………………………………………………………………………………….

From……… Gurgaon…….. (Village)…Delhi…….…. (Gewog)….. Delhi…………... (Dzongkhag) OR

working agency/local point of contact (for non-Bhutanese)…WAPCOS Limited PHEP-II, Bjimthangkha,
Wangdue Phodrang Dzongkhag / Arun Kumar, 17283518.......................... agree to the following
under the COVID- 19.

“Test-and-Go” protocol:

1. Undertake RT-PCR test at the point of entry upon arrival and provide proof of vaccination
(unless you are below 5 years old) or evidence of COVID-19 infection in the last six months.
If these conditions are not fulfilled, an individual shall undergo 5- day home or facility
quarantine.
2. Observe the mandatory stay home/hotel for 24 hours or until negative RT-PCR test is received.
3. Self-isolate for five days at home/hotel if the RT-PCT test is positive.
4. Make arrangements to travel by dedicated vehicle to the place of stay (home/hotel) that does
not entail an overnight halt without stopping in public places, entering shops/restaurants or
coming in contact with other people.
5. Ensure that family/household members’ movement will be restricted during the mandatory
24-hours stay and five days isolation period (if test is positive).
6. Be fully responsible for any breach of these protocol by me or my family/household members
and to be dealt as per the existing laws of the country.
7. If staying in a hotel, obtain a confirmation from the hotel that the “Test-and-Go” protocol in
terms of 24 hours mandatory stay and five days isolation (if test is positive) has been agreed
to by the hotel in keeping with COVID-19 safety protocol.

Additional details are attached.

Signature of applicant:
Name: Amit Ranjan
Residential Address: Delhi
Phone no: +975-17283518
Emergency Contact Person and number: +975-17283518

Page 1 of 2
 COVID-19 Test-and-Go
(Additional details)

1. Date of arrival (dd/mm/yy): 21.09.2022

Port of embarkation: Delhi, India

2. If you are traveling with family please provide the following details (separate

undertaking not required):

a) Name and contact number:

b) Name and contact number:

c) Name and contact number:

d) Name and contact number:

3. Place of stay/residence (location/name): PHPA-I, Project Colony Guest House, Bjimthangkha.

4. Number of household members: Alone

5. Details of person who will pick you up at the point of entry:

a) Name: Ugyen Tshewang

b) Contact number: +97517462096
c) Vehicle number:BG-1-A-3294 ( Innova)
d) Driver license number: PD-10692

Signature: Name:

Page 2 of 2
 COVID-19 Test-And-Go Undertaking

I, Mr./Ms./Dasho/………….. (Title) AMIT KUMAR GAUTAM ..................................... (Name)

Holding (CID/ Passport /Work permit number/Trading card license holder)

V 8482943….……………………………………………………………………….

From……… Gurgaon…….. (Village)…Delhi…….…. (Gewog)….. Delhi…………... (Dzongkhag) OR

working agency/local point of contact (for non-Bhutanese) WAPCOS Limited PHEP-II, Bjimthangkha,
Wangdue Phodrang Dzongkhag/ Arun Kumar, 17283518.......................... agree to the following
under the COVID- 19.
“Test-and-Go” protocol:

1. Undertake RT-PCR test at the point of entry upon arrival and provide proof of vaccination
(unless you are below 5 years old) or evidence of COVID-19 infection in the last six months.
If these conditions are not fulfilled, an individual shall undergo 5- day home or facility
quarantine.
2. Observe the mandatory stay home/hotel for 24 hours or until negative RT-PCR test is received.
3. Self-isolate for five days at home/hotel if the RT-PCT test is positive.
4. Make arrangements to travel by dedicated vehicle to the place of stay (home/hotel) that does
not entail an overnight halt without stopping in public places, entering shops/restaurants or
coming in contact with other people.
5. Ensure that family/household members’ movement will be restricted during the mandatory
24-hours stay and five days isolation period (if test is positive).
6. Be fully responsible for any breach of these protocol by me or my family/household members
and to be dealt as per the existing laws of the country.
7. If staying in a hotel, obtain a confirmation from the hotel that the “Test-and-Go” protocol in
terms of 24 hours mandatory stay and five days isolation (if test is positive) has been agreed
to by the hotel in keeping with COVID-19 safety protocol.

Additional details are attached.

Signature of applicant:
Name: Amit Kumar Gautam
Residential Address: Delhi
Phone no: +975-17283518
Emergency Contact Person and number: +975-17283518

Page 1 of 2
 COVID-19 Test-and-Go
(Additional details)

1. Date of arrival (dd/mm/yy): 21.09.2022

Port of embarkation: Delhi, India

2. If you are traveling with family please provide the following details (separate

undertaking not required):

a) Name and contact number:

b) Name and contact number:

c) Name and contact number:

d) Name and contact number:

3. Place of stay/residence (location/name): PHPA-I, Project Colony Guest House, Bjimthangkha.

4. Number of household members: Alone

5. Details of person who will pick you up at the point of entry:

a) Name: Jamtsho
b) Contact number: +97517605844
c) Vehicle number:BG-1-A-3441 (Scorpio)
d) Driver license number: PD-9452

Signature: Name:

Page 2 of 2
 COVID-19 Test-And-Go Undertaking

I, Mr./Ms./Dasho/………….. (Title) SAJAL MITTAL .................................................. (Name)

Holding (CID/Passport/Work permit number/Trading card license holder) L9542810

…………………………………………………………………………………………………….

From……… Gurgaon…….. (Village)…Delhi…….…. (Gewog)….. Delhi…………... (Dzongkhag)

OR working agency/local point of contact (for non-Bhutanese)…WAPCOS Limited PHEP-II,
Bjimthangkha, Wangdue Phodrang Dzongkhag /Arun Kumar, 17283518..........................
agree to the following under the COVID- 19.
“Test-and-Go” protocol:

1. Undertake RT-PCR test at the point of entry upon arrival and provide proof of
vaccination (unless you are below 5 years old) or evidence of COVID-19 infection in
the last six months. If these conditions are not fulfilled, an individual shall undergo 5-
day home or facility quarantine.
2. Observe the mandatory stay home/hotel for 24 hours or until negative RT-PCR test is
received.
3. Self-isolate for five days at home/hotel if the RT-PCT test is positive.
4. Make arrangements to travel by dedicated vehicle to the place of stay (home/hotel) that
does not entail an overnight halt without stopping in public places, entering
shops/restaurants or coming in contact with other people.
5. Ensure that family/household members’ movement will be restricted during the
mandatory 24-hours stay and five days isolation period (if test is positive).
6. Be fully responsible for any breach of these protocol by me or my family/household
members and to be dealt as per the existing laws of the country.
7. If staying in a hotel, obtain a confirmation from the hotel that the “Test-and-Go”
protocol in terms of 24 hours mandatory stay and five days isolation (if test is positive)
has been agreed to by the hotel in keeping with COVID-19 safety protocol.

Additional details are attached.

Signature of applicant:
Name: Sajal Mittal
Residential Address: Delhi
Phone no: +975-17283518
Emergency Contact Person and number: +975-17283518

Page 1 of 2
 COVID-19 Test-and-Go
(Additional details)

1. Date of arrival (dd/mm/yy): 21.09.2022

Port of embarkation: Delhi, India

2. If you are traveling with family please provide the following details (separate

undertaking not required):

a) Name and contact number:

b) Name and contact number:

c) Name and contact number:

d) Name and contact number:

3. Place of stay/residence (location/name): PHPA-I, Project Colony Guest House, Bjimthangkha.

4. Number of household members: Alone

5. Details of person who will pick you up at the point of entry:

a) Name: Jamtsho
b) Contact number: +97517605844
c) Vehicle number:BG-1-A-3441 (Scorpio)
d) Driver license number: PD-9452

Signature: Name:

Page 2 of 2
 COVID-19 Test-And-Go Undertaking

I, Mr./Ms./Dasho/………….. (Title) SHRAWAN KUMAR ......................................... (Name)

Holding (CID/Passport/Work permit number/Trading card license holder) S 8561671…………

………………………………………………………………………………………………………………

From……… Gurgaon…….. (Village)…Delhi…….…. (Gewog)….. Delhi…………... (Dzongkhag) OR

working agency/local point of contact (for non-Bhutanese)…WAPCOS Limited PHEP-II, Bjimthangkha,
Wangdue Phodrang Dzongkhag/Arun Kumar, 17283518.......................... agree to the following
under the COVID- 19

“Test-and-Go” protocol:

1. Undertake RT-PCR test at the point of entry upon arrival and provide proof of vaccination
(unless you are below 5 years old) or evidence of COVID-19 infection in the last six months.
If these conditions are not fulfilled, an individual shall undergo 5- day home or facility
quarantine.
2. Observe the mandatory stay home/hotel for 24 hours or until negative RT-PCR test is received.
3. Self-isolate for five days at home/hotel if the RT-PCT test is positive.
4. Make arrangements to travel by dedicated vehicle to the place of stay (home/hotel) that does
not entail an overnight halt without stopping in public places, entering shops/restaurants or
coming in contact with other people.
5. Ensure that family/household members’ movement will be restricted during the mandatory
24-hours stay and five days isolation period (if test is positive).
6. Be fully responsible for any breach of these protocol by me or my family/household members
and to be dealt as per the existing laws of the country.
7. If staying in a hotel, obtain a confirmation from the hotel that the “Test-and-Go” protocol in
terms of 24 hours mandatory stay and five days isolation (if test is positive) has been agreed
to by the hotel in keeping with COVID-19 safety protocol.

Additional details are attached.

Signature of applicant:
Name: Shrawan Kumar
Residential Address: Delhi
Phone no: +975-17283518
Emergency Contact Person and number: +975-17283518

Page 1 of 2
 COVID-19 Test-and-Go
(Additional details)

1. Date of arrival (dd/mm/yy): 21.09.2022

Port of embarkation: Delhi, India

2. If you are traveling with family please provide the following details (separate

undertaking not required):

a) Name and contact number:

b) Name and contact number:

c) Name and contact number:

d) Name and contact number:

3. Place of stay/residence (location/name): PHPA-I, Project Colony Guest House, Bjimthangkha.

4. Number of household members: Alone

5. Details of person who will pick you up at the point of entry:

a) Name: Jamtsho
b) Contact number: +97517605844
c) Vehicle number:BG-1-A-3441 (Scorpio)
d) Driver license number: PD-9452

Signature: Name:

Page 2 of 2
 COVID-19 Test-And-Go Undertaking

I, Mr./Ms./Dasho/………….. (Title) ABHINAV SRIVASTAVA................................... (Name)

Holding (CID/ Voter ID /Work permit number/Trading card license holder)

NLN1732642…………….……………………………………………………………………………

From……… Gurgaon…….. (Village)…Delhi…….…. (Gewog)….. Delhi…………... (Dzongkhag) OR

working agency/local point of contact (for non-Bhutanese)…WAPCOS Limited PHEP-II, Bjimthangkha,
Wangdue Phoadrang Dzongkhag/Arun Kumar, 17283518.......................... agree to the following
under the COVID- 19.

“Test-and-Go” protocol:

1. Undertake RT-PCR test at the point of entry upon arrival and provide proof of vaccination
(unless you are below 5 years old) or evidence of COVID-19 infection in the last six months.
If these conditions are not fulfilled, an individual shall undergo 5- day home or facility
quarantine.
2. Observe the mandatory stay home/hotel for 24 hours or until negative RT-PCR test is received.
3. Self-isolate for five days at home/hotel if the RT-PCT test is positive.
4. Make arrangements to travel by dedicated vehicle to the place of stay (home/hotel) that does
not entail an overnight halt without stopping in public places, entering shops/restaurants or
coming in contact with other people.
5. Ensure that family/household members’ movement will be restricted during the mandatory
24-hours stay and five days isolation period (if test is positive).
6. Be fully responsible for any breach of these protocol by me or my family/household members
and to be dealt as per the existing laws of the country.
7. If staying in a hotel, obtain a confirmation from the hotel that the “Test-and-Go” protocol in
terms of 24 hours mandatory stay and five days isolation (if test is positive) has been agreed
to by the hotel in keeping with COVID-19 safety protocol.

Additional details are attached.

Signature of applicant:
Name: Abhinav Srivastava
Residential Address: Delhi
Phone no: +975-17283518
Emergency Contact Person and number: +975-17283518

Page 1 of 2
 COVID-19 Test-and-Go
(Additional details)

1. Date of arrival (dd/mm/yy): 21.09.2022

Port of embarkation: Delhi, India

2. If you are traveling with family please provide the following details (separate

undertaking not required):

a) Name and contact number:

b) Name and contact number:

c) Name and contact number:

d) Name and contact number:

3. Place of stay/residence (location/name): PHPA-I, Project Colony Guest House, Bjimthangkha..

4. Number of household members: Alone

5. Details of person who will pick you up at the point of entry:

a) Name: Mindu
b) Contact number: +97517600349
c) Vehicle number:BG-2-A-1214 (Scorpio)
d) Driver license number: PD-3039

Signature: Name:

Page 2 of 2
 COVID-19 Test-And-Go Undertaking

I, Mr./Ms./Dasho/………….. (Title) KARUNAKARAN VYSAKH ............................... (Name)

Holding (CID/ Voter ID /Work permit number/Trading card license holder)

SJE1554889…………….………………………………………………………………………………….

From……… Gurgaon…….. (Village)…Delhi…….…. (Gewog)….. Delhi…………... (Dzongkhag) OR

working agency/local point of contact (for non-Bhutanese)…WAPCOS Limited PHEP-II, Bjimthangkha,
Wangdue Phodrang Dzongkhag / Arun Kumar, 17283518.......................... agree to the following
under the COVID- 19.

“Test-and-Go” protocol:

1. Undertake RT-PCR test at the point of entry upon arrival and provide proof of vaccination
(unless you are below 5 years old) or evidence of COVID-19 infection in the last six months.
If these conditions are not fulfilled, an individual shall undergo 5- day home or facility
quarantine.
2. Observe the mandatory stay home/hotel for 24 hours or until negative RT-PCR test is received.
3. Self-isolate for five days at home/hotel if the RT-PCT test is positive.
4. Make arrangements to travel by dedicated vehicle to the place of stay (home/hotel) that does
not entail an overnight halt without stopping in public places, entering shops/restaurants or
coming in contact with other people.
5. Ensure that family/household members’ movement will be restricted during the mandatory
24-hours stay and five days isolation period (if test is positive).
6. Be fully responsible for any breach of these protocol by me or my family/household members
and to be dealt as per the existing laws of the country.
7. If staying in a hotel, obtain a confirmation from the hotel that the “Test-and-Go” protocol in
terms of 24 hours mandatory stay and five days isolation (if test is positive) has been agreed
to by the hotel in keeping with COVID-19 safety protocol.

Additional details are attached.

Signature of applicant:
Name: Karunakaran Vysakh
Residential Address: Delhi
Phone no: +975-17283518
Emergency Contact Person and number: +975-17283518

Page 1 of 2
 COVID-19 Test-and-Go
(Additional details)

1. Date of arrival (dd/mm/yy): 21.09.2022

Port of embarkation: Delhi, India

2. If you are traveling with family please provide the following details (separate

undertaking not required):

a) Name and contact number:

b) Name and contact number:

c) Name and contact number:

d) Name and contact number:

3. Place of stay/residence (location/name): PHPA-I, Project Colony Guest House, Bjimthangkha.

4. Number of household members: Alone

5. Details of person who will pick you up at the point of entry:

a) Name: Mindu
b) Contact number: +97517600349
c) Vehicle number:BG-2-A-1214 (Scorpio)
d) Driver license number: PD-3039

Signature: Name:

Page 2 of 2