This declaration must be attached to all online permit applications or forwarded to
May 2020 Page 2 of 2
Are you applying for an exemption from border quarantine in order to directly
enter Aboriginal land after crossing the NT border?
Yes ☐ No ☐
If yes, you must provide evidence of your exemption quarantine conditions. CLC will assess these before
issuing a permit.
Do you have any of the following COVID-19 symptoms?
Cough without fever ☐
Sore throat ☐
Body aches, muscle or joint pain ☐
Other (please specify)
I, hereby declare that:
• I have accurately provided all trav
el and illness information required of me in regard to
the past 14 days
• I have not knowingly come into contact with positive cases of COVID-19
• If I travel outside the Northern Territory during the period of a valid permit, I must re-
submit an updated CLC COVID-19 Declaration to email@example.com
• If I have any of the symptoms listed above, my permit to Aboriginal land is invalidated.
• In the event of a positive test for COVID-19 my permit will be invalidated