Self Declaration form details for international arriving passengers

Applications are being accepted on behalf of the Ministry of Health and Family Welfare, Government of India

___ PASSENGER DETAILS ___

Registration Number
SR2301200321908

Name Flight Number

ANDREWSSTALIN ARULSAMY TR564

Nationality Passport Number

INDIA W1216336

Date of Arrival Country of Departure ( Origin )

22/01/2023 SINGAPORE

Date of RT-PCR Test Taken RT-PCR Negative Certificate Upload

20/01/2023 YES

First Airport of Entry Final Destination Address

TRICHY AIRPORT TIRUCHIRAPPALLI

Final Destination State/Union Territories Final Destination District/City

TAMIL NADU TIRUCHIRAPPALLI

Final Destination Pincode Mobile Number

621711 +918012970104

Email ID Details of the Countries visited in last 14

days?
CUTESTALIN@GMAIL.COM NONE

Are you a Transit Passenger? Country of Transit

NO -

Transit Flight Number ( Arriving in India )

-

How many passengers are travelling with you in the same flight and to the same final destination?
0

I/We have agreed to the following terms:

I agree to the guidelines issued by Ministry of Health & Family Welfare.
I undertake to quarantine/self monitor/take the self paid Covid-19 test on arrival as applicable to me as per the latest
MOHFW guidelines.
I, the primary applicant/passenger, authorise to be contacted by the Ministry of Health and Family Welfare, Government
of India, for the purpose of identification and related checks of my co-passenger(s), if required. In case of any default, the
primary applicant will be liable for punishable offences under the provisions of the relevant Indian Laws. I also agree to
the terms & conditions.
I, the primary applicant, certify that the information filled is correct and true.
For latest travel advisory kindly visit the link, https://www.newdelhiairport.in/covid19