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Self Health Declaration Form: DEL BBI

Shakti Swarup Jena has completed a self-health declaration form for an IndiGo flight from Delhi to Bhubaneswar on October 27, 2021. In the form, Jena declares that they are not COVID-19 positive, do not reside in a containment zone, and do not have any COVID symptoms. Jena also agrees to follow all health protocols of the destination state. The document provides travel advisories reminding passengers to wear masks, maintain social distancing, and comply with crew instructions.

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44 views

Self Health Declaration Form: DEL BBI

Shakti Swarup Jena has completed a self-health declaration form for an IndiGo flight from Delhi to Bhubaneswar on October 27, 2021. In the form, Jena declares that they are not COVID-19 positive, do not reside in a containment zone, and do not have any COVID symptoms. Jena also agrees to follow all health protocols of the destination state. The document provides travel advisories reminding passengers to wear masks, maintain social distancing, and comply with crew instructions.

Uploaded by

swati jena
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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10/26/21, 7:02 PM Print

Please carry the print of this page on the day of Travel

Self health declaration form


DEL  BBI
Delhi(T2) - Bhubaneswar 27 Oct 2021, 16:00 - 18:10 6E 2183 PNR - WJFPVF

Shakti Swarup Jena

Mobile No 91 9811650315

Email Id [email protected]

Destination address C/o-Dr.Raja Kishore Jena, BDA COLONY, PRIVATE PLO

Destination Pin code 752056

COVID Status I am not COVID-19 positive.

I have declared that:

I am not residing in any containment zone.

I am not suffering from any fever, cough, or any respiratory distress.

I am not under quarantine.

If I ever develop any of the above mentioned symptoms I will immediately contact the concerned health authorities.

I have not tested COVID-19 positive in the last three weeks.

I am eligible to travel as per the extant norms.

I will make my mobile number/ contact details available to IndiGo, whenever required by them.

I understand that if I undertake the air journey without meeting the eligibility criteria, I would be liable to penal action.

I will adhere to the health protocol prescribed by the destination state/ union territory.

https://www.goindigo.in/check-in/print.html?sk=6E~2183~ ~~DEL~10/27/2021 16:00~BBI~10/27/2021 18:10~~&sps=1&checkin=true 1/2


10/26/21, 7:02 PM Print

Travel advisory: Safety during COVID-19


We seek your kind assistance to safeguard your well-being, as well as that of your fellow passengers and our crew
on board our flights, by following the guidelines set out below:
• All customers should wear a mask and sanitize their hands before proceeding to the boarding gate.
• Customers must wear a face mask covering their nose and mouth, throughout their journey with IndiGo. The mask may
be removed only while eating and drinking.
• Please maintain appropriate social distancing while boarding and de-boarding the aircraft.
• Kindly adhere to all the announcements and other directives issued by our ground staff and/or crew at all points of time
during your journey.
• Customers are also requested to familiarise themselves with the guidelines for air passengers published by the Indian Ministry of Civil
Aviation on the following link:
https://www.civilaviation.gov.in/sites/default/files/Guidelines_for_Air_Passengers_21May.pdf
https://www.mohfw.gov.in/pdf/Guidelinesfordomestictravelflighttrainshipbusinterstatetravel.pdf

• Caution: Customers are advised to strictly follow all COVID-19 protocols. Failure to comply with these guidelines
and the directions of our ground staff and/or crew may attract penal action against the concerned individual.

https://www.goindigo.in/check-in/print.html?sk=6E~2183~ ~~DEL~10/27/2021 16:00~BBI~10/27/2021 18:10~~&sps=1&checkin=true 2/2

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