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BRUNEI PUBLIC SERVANT DECLARATION FORM: FULL COMPLIANCE AND VISITING COUNTRIES AFFECTED BY THE COVID-19 INFECTION

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PUBLIC SERVANT DECLARATION FORM: FULL COMPLIANCE AND
VISITING COUNTRIES AFFECTED BY THE COVID-19 INFECTION
Public Servant’s Full Name :
I am the public servant above and I hereby declare that -
1. I have read and fully understand the various press release, information, advice,
policy, guidelines, publications and materials issued by the Ministry of Health
before and on the day of my departure pertaining to the current COVID-19
infection, including among others and not limited to the following:
a. Press releases dated 10, 11, 12, 13, 14 and 15 March 2020: Media Statement
on the Current COVID-19 Infection in Brunei Darussalam;
b. Press release dated 9 March 2020: Detection of the First Case of COVID-19
Infection in Brunei Darussalam;
c. Press release dated 11 February 2020 and 5 March 2020: Health Information
on the Current Situation of the Coronavirus (COVID-19) Infection;
d. Press release dated 4 February 2020: Health Advice Line;
e. Press release dated 4 February 2020: Information on Self-Isolation for
Individuals who have Returned to Brunei Darussalam from the People’s
Republic of China;
f. Press release dated 30 January 2020: Current Situation of the Novel
Coronavirus (COVID-19) Infection and Measures Taken by Brunei Darussalam;
g. Self-Isolation Policy; and
h. “Steps you Can Take to Clean and Disinfect your Home”;
2. Further, I have read, kept up-to-date and fully understood all the guidelines in the
circulars (surat keliling) issued by the Prime Minister’s Office (JPM) before and
on the day of departure that concern public servants, including the following –
a. Surat Keliling Jabatan Perdana Menteri Bil: 06/2020: Garis Panduan
Pengawalan dan Menangani Pandemik COVID-19 bagi Warga Perkhidmatan
Awam Negara Brunei Darussalam;
… /2
- 2 –
b. Surat Keliling Jabatan Perdana Menteri Bil: 05/2020: Pengemaskinian
Garispanduan Langkah Persediaan Dan Pencegahan Jangkitan Coronavirus
(COVID-19) Bagi Perkhidmatan Awam Negara Brunei Darussalam;
c. Surat Keliling Jabatan Perdana Menteri Bil: 03/2020: Pengemaskinian
Garispanduan Langkah Persediaan dan Pencegahan Jangkitan Coronavirus
Baru (COVID-19) bagi Perkhidmatan Awam Negara Brunei Darussalam; and
d. Surat Keliling Jabatan Perdana Menteri Bil: 01/2020: Garispanduan Langkah
Persediaan dan Pencegahan Jangkitan Coronavirus Baru (2019-Ncov) bagi
Perkhidmatan Awam Negara Brunei Darussalam.
3. In accordance with the above, I will comply with any travel advisories and
restrictions in force, until approval has been granted by the relevant authorities of
Brunei Darussalam;
4. I understand that the above are important and failure to comply may pose a risk
to my health, safety and welfare and the vulnerable associated with family, friends
and people in close contact with me, as well as compromising safeguarding
provisions for myself and those around me in the event of emergencies; and
5. I hereby commit to full compliance with the above. However, due to
unavoidable circumstances, namely, , it
is essential for me to travel to as stated
in my JPM application with supporting documents
. I do so at my own
risk and accept full responsibility for any consequences of that decision.
____________________________________
Public Servant’s Signature
____________________________________
Date
____________________________________
Head of Department’s Signature
____________________________________
Date
____________________________________
Head of Department’s Name
____________________________________
Department’s Name
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BRUNEI PUBLIC SERVANT DECLARATION FORM: FULL COMPLIANCE AND VISITING COUNTRIES AFFECTED BY THE COVID-19 INFECTION

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Completed 29 March 2020

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