Health Declaration Form
(All your information shall be kept confidential and will be used only for contact tracing)
Email address *
In light of the COVID-19 (coronavirus) outbreak, the Ministry of Health, Royal Government of Bhutan mandatorily requires all passengers arriving by all modes of transport to fill in this form.
Name: *
Age: *
Sex *
Nationality *
Passport No.:
CID (Bhutanese):
Flight No.: *
Seat No.: *
Port of first embarkation (Origin): *
List of transit countries: *
Port of last embarkation: *
Date of Arrival: *
MM
/
DD
/
YYYY
Date of Departure from Bhutan (if applicable)
MM
/
DD
/
YYYY
List of countries visited in the last 2 weeks: *
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