Skip Ribbon Commands
Skip to main content

DECLARATION FORM

Institution I intend to go to
I am​​

Please provide your particulars​

​Your Name
Your NRIC / FIN / Passport​​
Mobile No​​
I am going to​​
Date​​

Declaration by Patient/Visitor​​

​1. Do you have a fever, cough, shortness of breath, blocked or runny nose or sore throat?
2. Have you had close contact with someone with COVID-19 in the last 14 days?
3. Have you travelled outside of Singapore in last 14 days?​​
The information you provide is important in managing the risk of COVID-19 transmission. The Infectious Diseases Act requires a person who has reason to suspect that he is a case or carrier of COVID-19, or has had contact with a person with COVID-19, to act in a responsible manner to not expose other persons to the risk of infection by the disease.

​