Name & Surname

ID Passport Number

Email Address

Nationality

Next of Kin and there contact number

1) Do you have any notable chronic conditions or feel you have general poor health? * YES or NO

If yes to 1 above, Please specify.

Have you been in contact with a suspected or confirmed case of COVID-19?

Do you have any of the following symptoms Do you have any of the following symptoms Sore throat Dry cough Fever Body aches Difficulty breathing Loss of taste or smell Any flu like symptoms None of the above

Have you been to an event with more than 50 people in the last 14 days?

List of countries you have been to prior to your arrival (INTERNATIONAL GUESTS ONLY)

Date completed

POPIA ACT 2021 POPIA ACT 2021 Do you accept the websites T&C's