International Health Regulations (IHR 2005) and the Egyptian Quarantine law,
this Public Health Declaration Form is a mandatory document and aims to protect
your health. Your information will help public health officers contact you if
you were exposed to a communicable disease. It is important to fill out this
form completely and accurately.
I, the undersigned, hereby confirm that
all the information I provide below is correct and that I have neither been
recently diagnosed with COVID-19, nor did I, knowingly, have had close contact
with any person suspected or tested positive for COVID-19, nor have I not
suffered from any symptoms during the past 14
I certify that I am currently
covered by an overseas medical insurance plan valid until the date of my
departure from Egypt.
Date of Birth:
Day Month Year
- Mobile Number:
- Flight Number Arriving from:
- Address in Egypt:
- E-mail Address:
- Insurance Details:
- Do you have
symptoms such as high fever, cough, sore throat and shortness of breath?
- In the last 14 days, have you had
contact with someone who tested with COVID-19? Yes No
- Which country / countries
have you visited (full route) during the past 14 days?
Should I experience any symptoms of
COVID-19 during my stay in Egypt, I will immediately report the incident to the
hotel management and doctor and seek the necessary medical assistance, or call
Should I change the above
mentioned address or phone number during my stay in Egypt I will call 105 to
give the new information.
In case I violate the above, the
Egyptian Government shall not be subject to any liability, whatsoever, if I
show evidence of positive testing for COVID-19 during the 14 days after
Failure to submit this declaration will result in an illegal entry to
I hereby confirm that I have read
and understood all of the above.
Signature: ………………………………………….. Date: …………………………………………..