Guest Self Declaration Form
Date of Declaration (no more that 48hr before arrival)
*
/
Day
/
Month
Year
Date
Guest Name
*
Gender M/F
CELL PHONE details
*
Date of Birth
*
-
Month
-
Day
Year
Date
Email
*
Confirmation Email
example@example.com
Nationality & ID NUMBER
*
FULL Permanent Address,
*
Mode of transportation with details of Flight/ Train/Car
Arrival date
*
/
Day
/
Month
Year
Date
Checkout Date
*
/
Day
/
Month
Year
Date
Purpose of visit (Optional)
Have you travelled abroad during 2020
*
Yes
No
Have you been vaccinated
*
Single Jab
Double Jab
Not Vaccinated
Have you been in contact with people being infected or diagnosed with COVID 19
*
Yes
No
If Yes, Please Enter Details
Do you have in the past 10 days any of the following Clinical Criteria (Symptoms)
*
Rows
Yes
No
High Temperature
Cough
Shortness of Breath
Persistent Pain in Chest
Loss of Smell or Taste
Have you had a Covid-19 test
Preview Response
Submit
Should be Empty: