Covid19 Declaration Form

Your Full Name

Your IC/Passport no

Have you visited any local RED ZONE announced by MOH in the last 14 days?

No

Yes

Have you been in close contact with someone who is positive Covid-19 in the last 14 days?

No

Yes

Have you ever attended any event / visited any place involving a suspected case / positive Covid-19 case in the last 14 days?

No

Yes

Are you a KKM volunteer or frontline officer in curbing Covid-19 cases within 14 days?

No

Yes

I hereby declare that my answers are all "NO" to the questionnaires above. This also applies to my friends or family members who travel with me