Fillable Coronavirus (COVID-19): declaration form 29 March 2021 for (Cabinet Office)

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Coronavirus (COVID-19): declaration form 29 March 2021 for (Cabinet Office)

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The Coronavirus (COVID-19): declaration form 29 March 2021 for (Cabinet Office) form is 3 pages long and contains:

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  • 6 check-boxes
  • 11 other fields

Country of origin: UK
File type: PDF

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Coronavirus (COVID-19): declaration form
for international travel from England before
29 March 2021
You must complete this form
to confirm that you are outside o
f
your home
to
travel
abroad for
a legally permitted reason. Different rules apply
in
Northern
Ireland,
Scotland
and
Wales.
This requirement applies
to
people
travelling
outside the UK from England.
You don’t
need to complete the form to travel to Ireland, the Channel
Islands or the Isle of Man
if that is your
final destination.
Legally permitted reasons
for international travel
include:
• work
• volunteering
• education
• medical, or compassionate grounds
• weddings, funerals and related events
Find out more about the legally permitted reasons.
Some people do not need to complete the form because of the job they do.
You do not need to complete the form yourself if you are under the age of 18 or if you
lack capacity to complete the form. If a responsible adult is travelling with you,
they must complete a separate copy of the form on your behalf.
Print a copy of the completed form or save it to a mobile phone or other device.
You may be required to present this declaration and asked for any evidence to support
your reason for travel at your port of departure.
Keep this form with you – police may ask to see it but will not collect it from you.
1
Declaration for international travel
Details of the traveller
Given name(s):
Surname:
Date of birth (dd / m m / y y y y):
Nationality:
Home address:
Passport number, or travel document reference number (as appropriate):
Destination:
2
I hereby declare that my reason for being outside my home to travel
internationally is for:
Work
Volunteering
Education
Medical, or compassionate reasons
Wedding, funeral or related event
Other permitted reasons – please specify:
Declaration
I certify that the information I have provided is true. I understand that if I provide false or
misleading information, I may be issued with a fixed penalty notice and/or a direction to
return home; or be arrested.
Signature:
If completing electronically, write your full name.
Write your full name if you are signing the form on behalf of another traveller:
Date (dd/mm/yyyy):
3
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Coronavirus (COVID-19): declaration form 29 March 2021 for (Cabinet Office)

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Completed 23 March 2021

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