Self Declaration Form

As a redefined process and mandated by health authorities you are requested to submit a Self-Declaration form and inform your travel history along with the purpose of visit.
* Required

Salutation *

First Name *

Last Name *

Email Address *

Phone Number *

Confirmation Number *

Hotel Name *

Have you travelled abroad during 2020? *
YesNo

Have you been in contact with people being infected, suspected or diagnosed with COVID-19? *
YesNo

Please state whether you've experienced/are experiencing the following *
FeverCoughShortness of BreathPersistent Pain in the Chest

I acknowledge that the information I've given is accurate and complete. *
I Agree

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