Health Declaration Card

-- Please read before proceeding --

In compliance with RA 10173 or Data Privacy Act of the Philippines, the personal information you will be providing below shall not be used for other purposes except for COVID-19 contact-tracing activities.



   
* Email:
* Mobile No:  
* First Name:  
Middle Name:
* Last Name:  
* Sex:
* Age Group:
* Birthdate:  
* Nationality:  
* Country of Birth:  
* Occupation:  
* Passport No/Valid ID Type & No:  
Place of Issue:
Expiry Date:
* Street No. and Name of Street ( If applicable, indicate name of barangay)  
* Municipality:  
* Province :  
* Region:  

In compliance with Ordinance No. 239 Series of 2006 , AN ORDINANCE REQUIRING TOURISTS AND VISITORS TO REGISTER WITH THE MUNICIPAL TOURISM OFFICE BEFORE LEAVING FOR BORACAY, the personal information you will be providing below shall be used for tourism statistical reporting by LGU Malay.


* Country:  
* Complete Home Address  
* Place of ORIGIN:  
* Arrival Date:  
* Flight/Bus/Plate No/Vessel Name:  
Seat No:


* No of Visits to Boracay:  
* Travelling on Package Tour:
 
Place visited before Boracay:
Destination after Boracay:
 

RA 9271 Quarantine Act of 2004
Section 4.2 "...Individual found to be infected or has been exposed to infection considered as dangerous contact, may be isolated at any facility..."
Section 8.a "...fine of P20,000.00 to P50,000.00 or be imprisoned for 1 to 6 months or both."

Upon clicking submit, I am providing consent to sharing my information for contact tracing purposes, I confirm that the information I have given is true, correct and complete and that I understand failure to answer any question may have serious consequences under Philippines laws. (Article 171 and 172 of the Revised Penal Code of the Philippines)



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