General Declaration

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Owner Operator: ITA Airways

Marks of

Nationality and Registration: IT EIIFF Flight N°: AZ00678 Date: 01DEC/23

Departure from FCO Arrival at GRU

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FLIGHT ROUTING

(Place Column always to list origin, every en-route stop and destination)

PLACE CREW NAME PASSPORT BIRTH DATE

FCO - GRU ROSELLI GIACOMO
FCO - GRU MASI LORENZO
FCO - GRU D AGOSTINO ETTORE
FCO - GRU PROIETTI COLONNA LAURA YA7768278 1967-08-12
FCO - GRU CECCARELLI DANIELE
FCO - GRU DE LIO PATRIZIA
FCO - GRU DI SANTO SILVIA
FCO - GRU CALABRINI ANTONELLA
FCO - GRU BUONOCORE CARMINE
FCO - GRU MANZONI MONICA
FCO - GRU BRUNELLO BARBARA
FCO - GRU VALENTI PAOLO
FCO - GRU LA GANGA ANTONIO
FCO - GRU ANTONIAZZI DIMITRI
FCO - GRU BAJ SERENA
YB2565041 1975-06-06
YB0332957 1974-07-11
YA7406883 1970-08-07
YB3103205 1975-06-10
YB5589783 1971-05-26
YB5293461 1975-04-23
YB7166294 1964-11-09
YB4506996 1994-07-22
YB6186474 1970-01-02
YB5042170 1996-07-29
YB6435681 1973-05-10
YA8231327 1975-06-09
YB7056814 1970-03-28
YB3327826 1972-01-17
 NUMBER OF
PASSENGERS ON THIS
Declaration of Health* STAGE **

Departure Place FCO

Enbarking
Name and seat number or function of person on board with illness other than airsickness or the effects of
accidents, who may be suggering from a communicable disable a fewer – temperature 38°/100°F or ................................
greater – associated with one or more of the following sings or symptoms, e.g. Appearing deviously Through on same flight
unwell; persistent coughing; impaired breathing; persistent danhoea; persistent vomitig; skin rash;
brushing or bleeding without previous injury; or confusion of recent onset, increases the likelihood that ...............................
the person is suffering a communicable disease as well as such cases of illness disemblarked during a
previous stop; Arrival Place GRU
Disembarking
.......................................................................................................................................................................
..........................
....................................................................................................................................................................... Through on same flight

....................................................................................................................................................................... ...............................
Details of each disinfecting or sanitary treatment (place,date,time,method) during the flight. If no
For official use only
disinfecting has been carried out during the flight, give details of most recent disinfection:

.......................................................................................................................................................................

.......................................................................................................................................................................

Sign, if required ...............................................................................................................

Crew member concerned

I decline the statements and particulars condition in the General Declaration, and in any supplementary SIGNATURE
forms required to be presented with this General Declaration and complete agent and true to the best of
my knowledge and that all throught passengers will continue on the flight. ..............................................
Authorized Agent or Pilot
in command
* To be completed only when required by the ..........
** Not to be completed when passenger ....... are presented and to be completed only when required by the .......
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