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Health Declaration Form

NTUC Club and its entities are adhering to the advisories issued by the Ministry of Health. Your cooperation is much appreciated.

 

Part A: Particulars of Visitor

Note: Date and time of visit will be defaulted to the date/time of submitting this form

 

Part B: Health Declaration – Pls Select Yes or No

 

1. Do you have flu-like symptoms e.g. fever, cough, sore throat, runny nose, breathlessness?
2. Have you travelled overseas within the last 14 days?
3. Have you or your family members had close contact with any persons who have been diagnosed with COVID-19?
4. Have you been contacted by MOH/MND as part of contact tracing?
I hereby declare that I have answered the above questions truthfully and to the best of my knowledge.


By clicking submit,
I agree that my personal information furnished would be used by NTUC Club and/or relevant authorities for contact tracing or other health-related purposes.