INBOUND TRAVEL (REGISTRATION FORM)

ALWAYS BRING VALID ID

TRAVEL INFORMATION

PETSA NG PAGLALAKBAY/DATE OF TRAVEL *

YYYY

PURPOSE *

PANGGAGALINGAN/POINT OF ORIGIN (Complete Address) *

MODE OF TRANSPORTATION

TYPE OF VEHICLE *

PLATE NUMBER *

DESTINATION DETAILS

HOUSE NUMBER *

STREET/SITIO *

BARANGAY *

MUNICIPALITY *

PERSONAL INFORMATION

FAMILY NAME *

FIRST NAME *

MIDDLE NAME *

CONTACT NUMBER *

EMAIL ADDRESS (YAHOO/GMAIL/HOTMAIL ONLY) *

REMARKS (Kindly give more details of your Travel.)

QUARANTINE PREFERENCE *

HOME ISOLATION (Should be a separate room with own bathroom and Comfort room)

MUNICIPAL/BARANGAY FACILITIES

HEALTH DECLARATION FORM

PLS BE HONEST WITH YOUR ANSWERS

Are you experiencing any of the following? *

Fever

Dry Cough

Sore Throat

Shortness of Breath

Loss of Smell and Taste

Fatigue

Aches and Pains

Runny Nose

Diarrhea

Headache

None of the Above

Required

I hereby certify that the above information is true and complete. I understand that my failure to answer, or any false or misleading information given by me may be used as a ground for the filing of cases against me under Article 171 and the Revised Penal Code of the Philippines, or Republic Act No. 11332, otherwise known as the "Law on Reporting of Communicable Disease"

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