Health and Declaration Form

Full Name (accordingly to NRIC/Passport)*
Contact Number*
Q1. Have you travelled to and from any country(ies) within the last 14 days? *
Q2. Are you currently serving Quarantine Order (QO), Leave of Absence (LOA) or Stay-Home Notice (SHN)?
Q3. Are you feeling unwell or having any respiratory symptoms (such as fever, cough, sore throat or runny nose)?*

If your answer to any of the above is "Yes", please contact the The Living Centre staff-in-charge now.

By submitting this form, you agree to provide your personal data prior to your visit/ meeting and understand that the data gathered is solely for contact tracing should the need arise.

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