Travel & Health Declaration Form

In view of COVID-19 situation in Singapore, X-Trekkers is taking precautionary measures by seeking your co-operation to complete the following travel & health declaration. Please indicate if you have/have not travelled outside of Singapore within the past 14 days.If you are feeling unwell or serving Stay Home Notice (SHN)/ taking Leave of Absence (LOA), we will postpone your participation without any penalty.Kindly submit your travel declaration within 2 working days from receipt of this notification. * Required
1. What Event Are You Attending?*
2. Event Start Date*
3. Full Name (as in NRIC/ PASSPORT)*
4. Last 3 digits and 1 letter of NRIC No (SXXXX123A) / FIN No (GXXXX123A) / Passport No (for Foreigners) *
5. Contact Number (For contact tracing)*
Email
6. Have you travelled outside Singapore within the last 14 days?*
7. If "yes" to Question 6, please specify the countries and cities that you have visited.
8. Have you been issued a Stay Home Notice or taking Leave of Absence in the past 14 days?*
9. If yes to Question 8, please indicate the period of SHN or LOA <dd/mm/yyyy to dd/mm/yyyy>
10. In the past 14 days, I have come in close contact with someone who is:*
11. Are you feeling unwell currently? (E.g Fever, cough sore throat, runny nose & breathlessness) **
I hereby declare that the above information provided is to the best of my knowledge and this is a truthful declaration. (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.) **
- Yes
- No
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