Health Declaration Card

-- Please read before proceeding --

In compliance with RA 10173 or Data Privacy Act of the Philippines, the personal information you will be providing in this form shall not be used for other purposes except for COVID-19 contact-tracing activities.

   
* Passport No/Valid ID Type & No:
* Mobile No:
* First Name:
Middle Name:
* Last Name:
* Sex:
* Nationality:
* Birthdate:
* Arrival Date:
* Passenger Type:
* Flight/Bus Number/Vessel Name :
Seat No:
* Name of Hotel/Place of stay IN AKLAN:
* Street No. and Name of Street ( If applicable, indicate name of barangay)
* Municipality:
* Province :
* Region:

* Age Group:
* Visitor Type:
* Occupation:
Place of Issue:
Expiry Date:
* Country of Residence:
* Country of Birth:
* FOR NON-PHILIPPINE RESIDENTS: Complete Home Address


* No of Visits to Boracay:
Intended lenght of Stay:
* Travelling on Package Tour:
Resort Name:
Cottage Name:
Residence of Friend/Relative:
Others:
Place visited before Boracay:
Destination after Boracay:

Upon clicking submit, I am providing consent to sharing my information for contact tracing purposes, I confirm that the information I have given is true, correct and complete and that I understand failure to answer any question may have serious consequences under Philippines laws. (Article 171 and 172 of the Revised Penal Code of the Philippines)

Enter Verification Code