5/1/22, 8:10 PM US Travel Requirement

Thank you, Tanya BAJAJ!

Confirmation Number: USCM235MAY02-047
Submission Date: May 1, 2022 at 08:10 PM

Passenger Attestation Summary

1- Passenger Attestation Requirement Relating to Proof of Negative COVID-19 Test Result or

Recovery from COVID-19

A. NEGATIVE PRE-DEPARTURE TEST RESULT

I attest that I have (or the person I am attesting on behalf of has) received a negative pre-departure test
result for COVID-19. The test was a viral test that was conducted on a specimen collected no more than 1
calendar day before the flight’s departure.

2- Passenger Attestation Requirement Relating to Presidential Proclamation on Advancing the

Safe Resumption of Global Travel During the COVID-19 Pandemic

A. FULLY VACCINATED (If you check box A, skip to signature page and sign the form to complete Attestation.)

I attest that I am (or the person I am attesting on behalf of is) fully vaccinated against COVID-19.

Contact Tracing Information

US Flight Information

Departure Date: May 2, 2022

Flight Number: CM 235
Departure Airport: Panama City (PTY)
Arrival Airport: Chicago (ORD)

Traveler Information
Name: Tanya
Last Name: BAJAJ
Email Address: tbajaj24@gmail.com
Phone Number: +507 69443744

Address Information
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5/1/22, 8:10 PM US Travel Requirement

Street Address: 216 East Ontario Street

City: Chicago
State: Illinois
Zip Code: 60611

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