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Traveller History

During the ongoing Covid-19 pandemic, We are extremely concerned about your health and would like to take best possible measures to keep you safe and healthy.
At this time we request you to kindly fill in the details as required hereunder.

Traveller History

During the ongoing Covid-19 pandemic, We are extremely concerned about your health and would like to take best possible measures to keep you safe and healthy.
At this time we request you to kindly fill in the details as required hereunder.

    First Name*

    Last Name*

    Your Email*

    Reason for visit*

    Have you experienced flu like following symptoms in the past 72 hours?

    Fever (100.3 deg or above)

    YesNo

    Breathlessness

    YesNo

    Cough

    YesNo

    Cold

    YesNo

    Have you or your immediate family members been to Corona virus affected areas within the country or abroad in the last 15 days?
    YesNo

    If yes,kindly provide travel details with specific dates and time.

    Have you or any immediate family members come into close contact with a confirmed case of Corona virus in the last 14 days? (“Close contact” means being at a distance of less than three feet for more than 15 minutes.)YesNo

    If yes,kindly provide details

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