Health & Travel Declaration Form – Muslim Converts' Association of Singapore

Date of Submission *

Full Name *

NRIC/FIN/PASSPORT *

Contact Number *

Have you been to overseas during the last 14 days? *

Have you been to any CoViD-19 infected country during the last 14 days? *

Do you have flu-like symptoms (e.g. fever, cough etc.)? *

Did you come into contact with someone who have returned from overseas and he/she is not feeling well in the past 14 days? *

Temperature (measured at Temperature Taking Station) *

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