100%
Visitor Declaration Form
Questions marked with a
*
are required
Name of Visitor
Company Name
Contact Number
Email Address
Intended Date of Visit
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
01
02
03
04
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07
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20
21
22
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28
29
30
31
Year
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Hrs.
01
02
03
04
05
06
07
08
09
10
11
12
Mins.
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
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39
40
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51
52
53
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58
59
AM
PM
Purpose of Visit
Lawyer-in-charge
Visit Location
Level 8
Level 17
Have you just returned from abroad (esp. India, Bangladesh, Nepal, Pakistan, Sri Lanka) within the last 14 days?
Yes
No
Have you been in contact with someone who has returned from abroad (esp. India, Bangladesh, Nepal, Pakistan, Sri Lanka) within the last 14 days?
Yes
No
Do you have a household member issued with a Quarantine Order or the Stay-Home Notice?
Yes
No
Have you been fully vaccinated and have taken an ART test in the last 7 days that shows negative result for Covid-19?
Yes
No
If you have not been fully vaccinated, have you taken an ART test in the last 4 days that shows negative result for COVID-19?
Yes
No
Are you feeling unwell?
Yes
No
I certify that the above responses are true, accurate and complete.
Yes
No
Done
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