REGISTRATION FOR COVID-19 TESTING FOR PERSON ENTERING MEGHALAYA

Coming From Details
Coming From:*
Foreign Country     Other States

State Coming From:*

Country Coming From:


Do you have a valid Final Certificate of vaccination:*
Yes No

Personal Details
First Name:*

Surname:*

Gender:*
Male Female Others

Date Of Birth:*

Age:*

Mobile Number:*
Email:

Purpose of Entry:*


Place of Stay:

View Entry & Exit Protocols

District:*

Select Urban/Rural
Rural Urban

Select Municipal Board/Town Committee

Block:

Village/Town:

Locality:

Postal Address:*

Hotel / Place of Stay: *
Hotel booking confirmation / proof of place of stay to be presented at the entry gate


Details of the Journey:

Entry/Journey Date:*

Transport Arrangement:


Flight No./Train No.:

Entry into Meghalaya from:*

Do You Have the following symptoms?
Fever
Yes No

Cough
Yes No

Breathing Difficulties
Yes No

Since when have you had these Symptons?

Declaration:
     I, hereby, declare that the information furnished above is true, complete and correct to the best of my knowledge and belief. I understand that in the event of my information being found false or incorrect, it shall invite penal action under the Epidemic Diseases Prevention Act, 1897.
Note: Fields with * are Mandatory