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?

Yes

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

Yes

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

Yes

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

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

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Note: Please fill out the fields marked with an asterisk.