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Health & Travel Declaration Form
Date of Submission
Purpose of Visit
40th AGM (29March2020)
Have you been to overseas during the last 14 days?
If Yes, State Country:
Are you on MC/LOA/SHN/Quarantine Order?
Do you have flu-like symptoms (e.g. fever, cough etc.)?
Did you meet with someone who have been diagnosed with CoViD-19 or suspected or under quarantine order in the past 14 days?
Temperature (measured at Temperature Taking Station)
I hereby declare that all the entries in this form are true and correct. I authorize Muslim Converts’ Association of Singapore, henceforth termed as MCAS, to disclose my personal information to its employees for administration and relevant authorities for contact tracing purposes. MCAS represent to, warrant and undertake that collective consents have been obtained allowing MCAS to collect, use, process and disclose the personal data in accordance with the terms and conditions as stated in the MCAS Personal Data Protection Policy available on our website (https://www.mcas.sg/corporate/pdpa/). Data collected will be disposed 30 days after visit.