Covid-19 Rapid Antigen test at Medijaya gateway@klia2
Kindly fill up the personal details of the individual who undergo the COVID-19 Test as below :
COVID-19 Test Profile
*
Covid-19 Rapid Antigen Test @ RM60
Full Name (as per I/C or Passport)
*
First Name
Last Name/Family Name
I/C Number :
(For Malaysian only)
Passport No. :
*
Nationality :
*
Gender :
*
Female
Male
Date of Birth :
*
-
Day
-
Month
Year
MySejahtera ID :
*
Handphone No :
*
-
Country Code
-
E-mail :
*
Arrival Date
*
-
Day
-
Month
Year
Flight Number
*
Address during your stay in Malaysia
*
Remark (if any)
Personal Data Protection Act 2020 - Consent on the Personal Data Processing
*
I hereby give my consent to Medijaya, its affiliate company and / or other third parties including Medijaya agents/contractors to collect and process my personal data in compliance with Personal Data Protection Act 2010. I understand that I am entitled to revoke my consent at any time by sending written notice to Medijaya.
Please verify that you are human
*
Submit
Should be Empty: