COVID-19 Declaration Form

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COVID-19 Declaration Form - Visitor

This form is a declaration made by you, the visitor, that you do not suffer from any symptoms of COVID-19, and have not been in contact with anybody displaying symptoms of or suffering from COVID-19 in the last 21 days.

Date of Visit *

YYYY

Visitor's Name *

Visitor's Company *

Phone Number *

Email ID *

Name of Flignite Host *

Enter the name of the Company/Individual who you're visiting. If you're visiting Flignite for an enquiry, kindly enter "Flignite".

Name of Flignite Centre *

Pinnacle 1.0 - Andheri East

Pinnacle 2.0 - Andheri East

Flignite Dadar

Other:

Do you have any symptoms of COVID-19 (eg. fever, dry cough, tiredness, loss of taste/smell, etc.)? *

Yes

Have you come in contact with any person suffering from COVID-19 or displaying any symptoms of COVID-19 in the last 21 days? *

Yes

Do you have the Aarogya Setu App? *

Yes

Submit

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