27. Have you visited any hospital in the last 14 days?. If the answer is YES, please mark w ith “X” the best option that describes this visit.
Hospital worker in contact with COVID-19 Visit for suspected CO VID-19
Hospital worker without contact with COVID-19 Visit for other reasons
28. Do you have a certificate of a negative result from a PCR test (COVID-19) carried out in the 72h prior to your arrival in Spain? (You may have to present the certificate of the result
29. Please indicate the country where you started your trip
30. Please indicate all countries/regions that you have been in including transit and stopover in the last 14 days prior to your arrival
31. Purpose for travel. Please, choose one.
Tourism Work Visit to relatives Special mission International Cooperation Another
I hereby give my commitment that if during the 14 days after entry to Spain I present symptoms of acute respiratory infection (fever, cough or shortness of breath), I will isolate
myself at home/place of residence, self-monitoring coronavirus symptoms, and I will contact the competent health authorities by telephone.
I agree to comply with those indications and measures indicated to me by the health authorities.
And for the record, I confirm the veracity of the information provided.
Check to accept:
In compliance with the provisions of Royal Decree-Law 23/2020, of June 23 and the Resolution of November 11, 2020, of the General Directorate of Public Health, all passengers
originating from any airport located outside of Spanish territory must complete this form. Your personal data will be processed in accordance with Regulation (EU) 2016/679 of the
European Parliament and of the Council of 27 April 2016 on the protection of natural persons with regard to the processing of their personal data and the free movement of such data
and Organic Law 3/2018, of 5 December, Protection of Personal Data and Guarantee of Digital Rights and other related reg ulations.