BVL
You have successfully submitted an Electronic Health Declaration to the Immigration & Checkpoints Authority.
This acknowledgement message will also be sent to the email address you have provided.
You may choose to download or print a copy of this acknowledgement.
Providing false health and travel declarations is an offence under Section 64(b) of Singapore's Infectious Diseases
Act. The penalty for providing false or misleading information is a fine of up to S$10,000 and/or imprisonment of
up to 6 months. For subsequent offence(s), the penalty is a fine up to S$20,000 and/or imprisonment of up to 12
months.
You are reminded that it is your responsibility to update and resubmit your declarations prior to your arrival in
Singapore if you recently visited a hospital, had contact with a COVID-19 case, and/or if there is any change in
your health status and/or travel history.
Transaction Date: 26/12/2021 11:51 AM (Singapore Time)
Electronic Health Declaration
Personal Information
NRIC/FIN
Email Address
*****161T
PISPIS272@GMAIL.COM
Mode of Travel
LAND
Mobile Number
Date of Arrival to Singapore
+65 86521758
28/12/2021
Type of Accommodation in Singapore
Name of Hotel
HOTEL
VALUE HOTEL - THOMSON
Health Declaration
Please indicate all countries/regions that you have been in (including the
country/region of embarkation) or travelled to, (excluding transit and stopover for
air travel only) in the last 14 days prior to your arrival in Singapore. To illustrate, if
your expected arrival date is on 15 January 2021, please indicate your travel
history from 1 to 15 January 2021 (both dates inclusive).
MALAYSIA
Do you have any of the following symptoms: fever, cough, runny nose, sore
throat, loss of sense of smell or shortness of breath?
NO
Are you diagnosed or suspected to have COVID-19 infection in the past 14 days?
NO
Did you have contact with any case of COVID-19 in the last 7 days?
NO
Do you have any critical medical conditions (e.g. cancer, heart diseases, stroke)
or do you require help to carry out your daily activities (e.g. eating, bathing,
dressing) or are you prone to falls?
NO
Do you have an overseas digital vaccination certificate?
N/A
If you are required to take COVID-19 Pre-Departure Test (PDT) under the current
requirements for entry into Singapore, you may scan/upload the QR code on the
digital PDT result (if available) here. Please refer to https://safetravel.ica.gov.sg/
shn-and-swab-summary for latest requirements.
N/A