Office Visit Health Declaration Form

Health Declaration Form

COVID 19
Your Consent

By submitting this form, you agree that European Chamber of Commerce, Singapore may collect, use, process and disclose my personal data for the purposes of contact tracing and other response measures in the event of any emergency. Our collection policy complies with Singapore’s Personal Data and Protection Act (2012).
NRIC/ FIN/ Passport No.*
YesNo

Personal Particulars

You will only need to fill in your personal particulars once. It will henceforth be logged in our system.
Full Name (as in NRIC)*
Mobile No.*

Travel & Health Check
YesNo
YesNo
YesNo
Fever (37.5 and above)Sore ThroatDry CoughRunny NoseBody AchesTirednessHeadachesShortness of BreathOther
Brunei DarussalamCambodiaIndonesiaLao PDRMalaysiaMyanmarthe PhilippinesThailandVietnamOther
Time of Arrival *

:HourMinutesAM/PM Option
Estimated time of Departure *

:HourMinutesAM/PM Option
Please verify that you are human*
Should be Empty: