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Self Declaration Form

This coronavirus self-declaration form requires candidates to provide personal information such as name, registration number, exam date and center. Candidates must declare whether they have traveled internationally in 2020 or been in contact with COVID-19 infected individuals. They must also confirm they are not experiencing symptoms such as fever, cough, shortness of breath or chest pain. By signing, candidates acknowledge the information provided is accurate and complete for the health and safety of the community.

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Avritti Mishra
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576 views1 page

Self Declaration Form

This coronavirus self-declaration form requires candidates to provide personal information such as name, registration number, exam date and center. Candidates must declare whether they have traveled internationally in 2020 or been in contact with COVID-19 infected individuals. They must also confirm they are not experiencing symptoms such as fever, cough, shortness of breath or chest pain. By signing, candidates acknowledge the information provided is accurate and complete for the health and safety of the community.

Uploaded by

Avritti Mishra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Coronavirus Self Declaration Form

For the health and safety of our community, declaration of illness is required. Be sure that the
information you'll give is accurate and complete.

Name of the Candidate: ______________________________________________


Reg No:_____________________________________________
Examination Date _______________________________________
Examination Time _________________________________________
Examination Centre __________________________________________

 I have not travelled to any foreign location in the year 2020.


 I am not being in contact with people being infected, suspected or diagnosed with
COVID-19?

I declare that I am not experiencing any of the below issues:


 Fever
 Cough
 Shortness of Breath
 Persistent Pain in the Chest

I acknowledge that the information I've given is accurate and complete.

Date _______________________

Signature __________________________

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