DRMS
COVID-19 Crisis Management Co-ordination Center (CCMCC), Kathmandu
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Fields marked with astrisk(*) are mandatory.
Domestic Travellers' Detail
Name (नाम)*
Surname (थर)*
Origin Airport (प्रस्थान एयरपोर्ट)
एयरपोर्ट छान्नुहोस्
Baglung => Dhorpatan Airport
Bajura => Bajura Airport
Chitwan => Bharatpur Airport
Jumla => Jumla Airport
Kailali => Dhangadhi Airport
Morang => Biratnagar Airport
Western Rukum => Rukum Chaurjahari Airport
Accham => Kamal Bazar Airport
Accham => Sanphebagar Airport
Baglung => Baglung Airport
Baitadi => Baitadi Airport
Bajhang => Bajhang Airport
Banke => Nepalgunj Airport
Bara => Simara Airport
Bhojpur => Bhojpur Airport
Chitwan => Meghauli Airport
Dang => Dang Airport
Darchula => Darchula Airport
Dhanusha => Janakpur Airport
Dolakha => Jiri Airport
Dolpa => Dolpa Airport
Dolpa => Masinechaur Airport
Doti => Silgadhi Airport
Gorkha => Palungtar Airport
Humla => Simikot Airport
Jhapa => Bhadrapur Airport
Kailali => Tikapur Airport
Kanchanpur => Mahendranagar Airport
Kaski => Pokhara Airport
Kathmandu => Tribhuvan International Airport
Khotang => Man Maya Airport
Khotang => Thamkharka Airport
Khotang => Lamidanda Airport
Manang => Manang Airport
Mugu => Talcha Airport
Mustang => Jomsom Airport
Okhladhunga => Rumjatar Airport
Ramechhap => Ramechhap Airport
Rasuwa => Langtang Airport
Rolpa => Rolpa Airport
Rupandehi => Gautam Buddha Airport
Sankhuwasabha => Tumlingtar Airport
Saptari => Rajbiraj Airport
Solukhumbu => Kangeldanda Airport
Solukhumbu => Tenzing-Hillary Airport
Solukhumbu => Phaplu Airport
Solukhumbu => Syangboche Airport
Surkhet => Surkhet Airport
Taplejung => Taplejung Airport
Western Rukum => Rukum Salle Airport
Destination Airport (गन्तव्य एयरपोर्ट)
एयरपोर्ट छान्नुहोस्
Baglung => Dhorpatan Airport
Bajura => Bajura Airport
Chitwan => Bharatpur Airport
Jumla => Jumla Airport
Kailali => Dhangadhi Airport
Morang => Biratnagar Airport
Western Rukum => Rukum Chaurjahari Airport
Accham => Kamal Bazar Airport
Accham => Sanphebagar Airport
Baglung => Baglung Airport
Baitadi => Baitadi Airport
Bajhang => Bajhang Airport
Banke => Nepalgunj Airport
Bara => Simara Airport
Bhojpur => Bhojpur Airport
Chitwan => Meghauli Airport
Dang => Dang Airport
Darchula => Darchula Airport
Dhanusha => Janakpur Airport
Dolakha => Jiri Airport
Dolpa => Dolpa Airport
Dolpa => Masinechaur Airport
Doti => Silgadhi Airport
Gorkha => Palungtar Airport
Humla => Simikot Airport
Jhapa => Bhadrapur Airport
Kailali => Tikapur Airport
Kanchanpur => Mahendranagar Airport
Kaski => Pokhara Airport
Kathmandu => Tribhuvan International Airport
Khotang => Man Maya Airport
Khotang => Thamkharka Airport
Khotang => Lamidanda Airport
Manang => Manang Airport
Mugu => Talcha Airport
Mustang => Jomsom Airport
Okhladhunga => Rumjatar Airport
Ramechhap => Ramechhap Airport
Rasuwa => Langtang Airport
Rolpa => Rolpa Airport
Rupandehi => Gautam Buddha Airport
Sankhuwasabha => Tumlingtar Airport
Saptari => Rajbiraj Airport
Solukhumbu => Kangeldanda Airport
Solukhumbu => Tenzing-Hillary Airport
Solukhumbu => Phaplu Airport
Solukhumbu => Syangboche Airport
Surkhet => Surkhet Airport
Taplejung => Taplejung Airport
Western Rukum => Rukum Salle Airport
Date of Travel (उडान मिति)
Flight No. (उडान नं.)
Seat No. (सिट नं.)
Nationality (राष्ट्रियता)*
CHOOSE COUNTRY
AFGHANISTAN [AFG]
ALAND ISLANDS [ALA]
ALBANIA [ALB]
ALGERIA [DZA]
AMERICAN SAMOA [ASM]
ANDORRA [AND]
ANGOLA [AGO]
ANGUILLA [AIA]
ANTARCTICA [ATA]
ANTIGUA AND BARBUDA [ATG]
ARGENTINA [ARG]
ARMENIA [ARM]
ARUBA [ABW]
AUSTRALIA [AUS]
AUSTRIA [AUT]
AZERBAIJAN [AZE]
BAHAMAS [BHS]
BAHRAIN [BHR]
BANGLADESH [BGD]
BARBADOS [BRB]
BELARUS [BLR]
BELGIUM [BEL]
BELIZE [BLZ]
BENIN [BEN]
BERMUDA [BMU]
BHUTAN [BTN]
BOLIVIA [BOL]
BONAIRE, SAINT EUSTATIUS AND SABA [BES]
BOSNIA AND HERZEGOVINA [BIH]
BOTSWANA [BWA]
BOUVET ISLAND [BVT]
BRAZIL [BRA]
BRITISH INDIAN OCEAN TERRITORY [IOT]
BRITISH VIRGIN ISLANDS [VGB]
BRUNEI [BRN]
BULGARIA [BGR]
BURKINA FASO [BFA]
BURUNDI [BDI]
CAMBODIA [KHM]
CAMEROON [CMR]
CANADA [CAN]
CAPE VERDE [CPV]
CAYMAN ISLANDS [CYM]
CENTRAL AFRICAN REPUBLIC [CAF]
CHAD [TCD]
CHILE [CHL]
CHINA [CHN]
CHRISTMAS ISLAND [CXR]
COCOS [KEELING] ISLANDS [CCK]
COLOMBIA [COL]
COMOROS [COM]
COOK ISLANDS [COK]
COSTA RICA [CRI]
CROATIA [HRV]
CUBA [CUB]
CURACAO [CUW]
CYPRUS [CYP]
CZECH REPUBLIC [CZE]
DEMOCRATIC REPUBLIC OF THE CONGO [COD]
DENMARK [DNK]
DJIBOUTI [DJI]
DOMINICA [DMA]
DOMINICAN REPUBLIC [DOM]
EAST TIMOR [TLS]
ECUADOR [ECU]
EGYPT [EGY]
EL SALVADOR [SLV]
EQUATORIAL GUINEA [GNQ]
ERITREA [ERI]
ESTONIA [EST]
ETHIOPIA [ETH]
FALKLAND ISLANDS [FLK]
FAROE ISLANDS [FRO]
FIJI [FJI]
FINLAND [FIN]
FRANCE [FR]
FRENCH GUIANA [GUF]
FRENCH POLYNESIA [PYF]
FRENCH SOUTHERN TERRITORIES [ATF]
GABON [GAB]
GAMBIA [GMB]
GEORGIA [GEO]
GERMANY [DEU]
GHANA [GHA]
GIBRALTAR [GIB]
GREECE [GRC]
GREENLAND [GRL]
GRENADA [GRD]
GUADELOUPE [GLP]
GUAM [GUM]
GUATEMALA [GTM]
GUERNSEY [GGY]
GUINEA [GIN]
GUINEA-BISSAU [GNB]
GUYANA [GUY]
HAITI [HTI]
HEARD ISLAND AND MCDONALD ISLANDS [HMD]
HONDURAS [HN]
HONG KONG [HK]
HUNGARY [HU]
ICELAND [IS]
INDIA [IN]
INDONESIA [ID]
IRAN [IR]
IRAQ [IQ]
IRELAND [IE]
ISLE OF MAN [IM]
ISRAEL [IL]
ITALY [IT]
IVORY COAST [CI]
JAMAICA [JM]
JAPAN [JP]
JERSEY [JE]
JORDAN [JO]
KAZAKHSTAN [KZ]
KENYA [KE]
KIRIBATI [KI]
KOSOVO [XK]
KUWAIT [KW]
KYRGYZSTAN [KG]
LAOS [LA]
LATVIA [LV]
LEBANON [LB]
LESOTHO [LS]
LIBERIA [LR]
LIBYA [LY]
LIECHTENSTEIN [LI]
LITHUANIA [LT]
LUXEMBOURG [LU]
MACAO [MO]
MACEDONIA [MK]
MADAGASCAR [MG]
MALAWI [MW]
MALAYSIA [MY]
MALDIVES [MV]
MALI [ML]
MALTA [MT]
MARSHALL ISLANDS [MH]
MARTINIQUE [MQ]
MAURITANIA [MR]
MAURITIUS [MU]
MAYOTTE [YT]
MEXICO [MX]
MICRONESIA [FM]
MOLDOVA [MD]
MONACO [MC]
MONGOLIA [MN]
MONTENEGRO [ME]
MONTSERRAT [MS]
MOROCCO [MA]
MOZAMBIQUE [MZ]
MYANMAR [BURMA] [MM]
NAMIBIA [NA]
NAURU [NR]
NEPAL [NP]
NETHERLANDS [NL]
NEW CALEDONIA [NC]
NEW ZEALAND [NZ]
NICARAGUA [NI]
NIGER [NE]
NIGERIA [NG]
NIUE [NU]
NORFOLK ISLAND [NF]
NORTH KOREA [KP]
NORTHERN MARIANA ISLANDS [MP]
NORWAY [NO]
OMAN [OM]
PAKISTAN [PK]
PALAU [PW]
PALESTINE [PS]
PANAMA [PA]
PAPUA NEW GUINEA [PG]
PARAGUAY [PY]
PERU [PE]
PHILIPPINES [PH]
PITCAIRN ISLANDS [PN]
POLAND [PL]
PORTUGAL [PT]
PUERTO RICO [PR]
QATAR [QA]
REPUBLIC OF THE CONGO [CG]
RéUNION [RE]
ROMANIA [RO]
RUSSIA [RU]
RWANDA [RW]
SAINT BARTHéLEMY [BL]
SAINT HELENA [SH]
SAINT KITTS AND NEVIS [KN]
SAINT LUCIA [LC]
SAINT MARTIN [MF]
SAINT PIERRE AND MIQUELON [PM]
SAINT VINCENT AND THE GRENADINES [VC]
SAMOA [WS]
SAN MARINO [SM]
SãO TOMé AND PRíNCIPE [ST]
SAUDI ARABIA [SA]
SENEGAL [SN]
SERBIA [RS]
SEYCHELLES [SC]
SIERRA LEONE [SL]
SINGAPORE [SG]
SINT MAARTEN [SX]
SLOVAKIA [SK]
SLOVENIA [SI]
SOLOMON ISLANDS [SB]
SOMALIA [SO]
SOUTH AFRICA [ZA]
SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS [GS]
SOUTH KOREA [KR]
SOUTH SUDAN [SS]
SPAIN [ES]
SRI LANKA [LK]
SUDAN [SD]
SURINAME [SR]
SVALBARD AND JAN MAYEN [SJ]
SWAZILAND [SZ]
SWEDEN [SE]
SWITZERLAND [CH]
SYRIA [SY]
TAIWAN [TW]
TAJIKISTAN [TJ]
TANZANIA [TZ]
THAILAND [TH]
TOGO [TG]
TOKELAU [TK]
TONGA [TO]
TRINIDAD AND TOBAGO [TT]
TUNISIA [TN]
TURKEY [TR]
TURKMENISTAN [TM]
TURKS AND CAICOS ISLANDS [TC]
TUVALU [TV]
U.S. MINOR OUTLYING ISLANDS [UM]
U.S. VIRGIN ISLANDS [VI]
UGANDA [UG]
UKRAINE [UA]
UNITED ARAB EMIRATES [UAE]
UNITED KINGDOM [UK]
UNITED STATES [USA]
URUGUAY [UY]
UZBEKISTAN [UZ]
VANUATU [VU]
VATICAN CITY [VA]
VENEZUELA [VE]
VIETNAM [VN]
WALLIS AND FUTUNA [WF]
WESTERN SAHARA [EH]
YEMEN [YE]
ZAMBIA [ZM]
ZIMBABWE [ZW]
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Passport/Citizenship/ID No. (राहदानी/नागरिकता/परिचय पत्र नं.)*
राहदानी
नागरिकता
अन्य परिचय पत्र
परिचय पत्र विवरण
Destination Details (गन्तव्य ठेगाना: जिल्ला)
जिल्ला
ACHHAM अछाम
ARGHAKHANCHI अर्घाखांची
BAGLUNG बाग्लुङ्ग
BAITADI बैतडी
BAJHANG बझाङ्ग
BAJURA बाजुरा
BANKE बांके
BARA बारा
BARDIYA बर्दिया
BHAKTAPUR भक्तपुर
BHOJPUR भोजपुर
CHITAWAN चितवन
DADELDHURA डडेल्धुरा
DAILEKH दैलेख
DANG दाङ्ग
DARCHULA दार्चुला
DHADING धादिङ्ग
DHANKUTA धनकुटा
DHANUSA धनुषा
DOLAKHA दोलखा
DOLPA डोल्पा
DOTI डोटी
EAST RUKUM पुर्व रुकुम
GORKHA गोरखा
GULMI गुल्मी
HUMLA हुम्ला
ILAM इलाम
JAJARKOT जाजरकोट
JHAPA झापा
JUMLA जुम्ला
KAILALI कैलाली
KALIKOT कालिकोट
KANCHANPUR कञ्चनपुर
KAPILBASTU कपिलवस्तु
KASKI कास्की
KATHMANDU काठमाण्डौं
KAVREPALANCHOK काभ्रेपलान्चोक
KHOTANG खोटाङ्ग
LALITPUR ललितपुर
LAMJUNG लमजुङ्ग
MAHOTTARI महोत्तरी
MAKWANPUR मकवानपुर
MANANG मनाङ्ग
MORANG मोरङ्ग
MUGU मुगु
MUSTANG मुस्ताङ्ग
MYAGDI म्याग्दी
NAWALPUR नवलपुर
NUWAKOT नुवाकोट
OKHALDHUNGA ओखलढुंगा
PALPA पाल्पा
PANCHTHAR पाँचथर
PARASI परासी
PARBAT पर्वत
PARSA पर्सा
PYUTHAN प्युठान
RAMECHHAP रामेछाप
RASUWA रसुवा
RAUTAHAT रौतहट
ROLPA रोल्पा
RUPANDEHI रुपन्देही
SALYAN सल्यान
SANKHUWASABHA संखुवासभा
SAPTARI सप्तरी
SARLAHI सर्लाही
SINDHULI सिन्धुली
SINDHUPALCHOK सिन्धुपाल्चोक
SIRAHA सिराहा
SOLUKHUMBU सोलुखुम्बु
SUNSARI सुनसरी
SURKHET सुर्खेत
SYANGJA स्याङ्जा
TANAHU तनहु
TAPLEJUNG तापलेजुङ्ग
TERHATHUM तेह्रथुम
UDAYAPUR उदयपुर
WEST RUKUM पश्चिम रुकुम
गन्तव्य ठेगाना : न.पा./गा.पा.
न.पा./गा.पा.
गन्तव्य ठेगाना: वडा नं.
वडा नं.
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गन्तव्य ठेगाना : गाँउ टोल
Mobile no (आफ्नो मोबाइल नं.*)
Email (ईमेल)
नजिकको सम्पर्क व्यक्तिको नामथर
नजिकको व्यक्तिसँगको सम्बन्ध
सम्बन्ध
FATHER
MOTHER
WIFE
HUSBAND
SON
DAUGHTER
GRAND FATHER
GRAND MOTHER
STEP MOTHER
BROTHER
SISTER
AUNT
MAIJU
MAMA
UNCLE
SISTER IN LAW
BROTHER-IN-LAW
DAUGHTER-IN-LAW
SON-IN-LAW
OTHER
FRIEND
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नजिकको व्यक्तिको सम्पर्क नं.
Covid Related Any Symptoms (कोभिड सम्बन्धी कुनै लक्षण*)
भएको
नभएको
Have you, or any member of your group travelling with you, had any of the following symptoms during the past 14 Days?
पछिल्ला १४ दिनमा तपाइँ वा तपाइँको समुदायमा यात्रा गरिरहनुभएका मध्ये कसैलाई निम्न लक्षण देखा परेका छन्?
Fever (ज्वरो)
Yes
No
Cough (खोकी)
Yes
No
Shortness of breath (स्वास प्रस्वासमा गाह्रोपन)
Yes
No
Sudden loss of sense of taste or smell (गन्ध वा स्वाद थाहा नपाउने)
Yes
No
Have you, or any member of your group travelling with you, had a positive COVID-19 test in the last three (3) days?
पछिल्ला ३ दिनमा तपाइँ वा तपाइँको समुदायमा यात्रा गरिरहनुभएका मध्ये कसैको कोभिड १९ परीक्षण भएको छ ?
Yes
No
During the last 14 Days, have you, or a member of your group travelling with you, had close contact with someone who had above mentioned symptoms?
पछिल्ला १४ दिनमा तपाइँ वा तपाइँको समुदायमा यात्रा गरिरहनुभएका मध्ये कोही प्रत्यक्ष वा शारीरिक रूपले माथि उल्लेखित लक्षण देखिएका व्यक्तिसँग सम्पर्कमा रहनुभएको छ ?
Yes
No
Please indicate all the countries and/or cities you have visited or transited through in the last 14 days, provide the dates of the visit. (List the most recent country first).
पछिल्ला १४ दिनमा तपाइँ वा तपाइँको समुदायले भ्रमण गर्नुभएका एयरपोर्ट, नाका, देश, आदिको संक्षिप्त वर्णन मिति अनुसार क्रमैसँग लेख्नुहोस्
Self-declaration (स्वघोषणा)
The above information is correct and I am subject to legal consequences if found otherwise. (उपरोक्त सवै विवरण ठिक छ झुटो ठहरे कारवाही भोग्न तयार छु।)
I will take utmost care to abide by the health directives of Government of Nepal to contain the possible spread of COVID 19 from me to my community. (मेरो कारणबाट परिवार र समाजमा यो रोग नफैलोस र यो रोगबाट आफू, परिवार र देशलाई बचाउन अनुसासनका सवै नियमहरु हुवहु पालना गर्नेछु।)
The above information is correct and I am subject to legal consequences if found otherwise. (उपरोक्त सवै विवरण ठिक छ झुटो ठहरे कारवाही भोग्न तयार छु ।*)
This form is Regulated By International Civil Aviation Organization ( अन्तर्राष्ट्रिय नागरिक उड्डयन सङ्गठनको नियम अनुसारको फारम)