Passenger Contact Information & Health Undertaking For Air India Express

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Applicable to Passengers travelling to/from/within Kerala

Email *

Passenger Name (One Name only if Booked in group/family) *

Destination Address *

Destination Pincode (eg. 400029) *

Present Location Details -Full Address *

City *

District *

Pincode (eg.400029) *

Gender *

Male

Female

Others

Age *

Mobile Phone Number (eg.98111 11125) *

LSGI name in Kerala *

LSGI ward no *

District in Kerala *

Norka/ e-Jagratha Registration ID *

Flight Number (eg IX 340) *

Departure Airport *

Arrival Airport *

Date of Journey *

YYYY

Submitted by:

Self or/and on behalf of group travelling together

Assisted and submitted by Airlines Staff on behalf of passenger

Clear selection

Do you fulfill all Health requirement as follows:

The Passenger shall give a declaration to the following effect

1.I/we am/are not residing in any containment zone.
2.I/we am/are not suffering from any fever/cough/any respiratory distress.
3.I/we am are/were not under quarantine.
4.If I/we develop any of the above-mentioned symptoms I/we shall contact the concerned health authorities immediately.
5.I/we have not tested COVID -19 is the last three weeks (COVID-19 recovered persons fulfilling this condition will be allowed to travel upon showing a COVID-19 recovered/discharged certificate from any institution dealing with COVID-19 subjects).
6.I/we am/are eligible to travel as per the extant norms.
7.I/we shall make my/our mobile number/s / contact details available to the airlines whenever required by them.
8.I/we understand that if I/we undertake the air journey without meeting the eligibility criteria I/we would be liable to penal action.
9.I/we undertake to adhere to the health protocol prescribed by the destination State / UT.

I/we fulfill all health requirements from 1 to 9 mentioned above *

Yes

I/We have no objection to the above information being shared with State/UT Government authorities.

A copy of your responses will be emailed to the address you provided.

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