COVID-19 Crisis Management Co-ordination Center (CCMCC), Kathmandu

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  • This form is prepared for the details of Passenger Locator and Health Declaration of the passengers.

1. Personal Details

2. Travel History (Past 30 Days)

From To Mode of Travel Flight/Vehicle No. Date Action

3. Travelling Country

4. Future Return Plan to Nepal

5. Health Information

For Ladies only

Self-Declaration

  • The above information is correct and I am subject to legal consequences if found otherwise.
  • I will abide by the health directives issued by the Government of Travelling Country during my stay in Quarantine.
  • I will take utmost care to abide by the health directives of the Government of Travelling Country to contain the possible spread of COVID 19 from me to the community.

© 2020 Covid-19 Crisis Management Center (CCMC). All Rights Reserved

Phone: +977-01-4200055
Email: joc@ccmc.gov.np
Toll Free No.: 1140