Personal Travel Attestation

PERSONAL TRAVEL ATTESTATION

I, the undersigned, make the following attestations regarding my upcoming travel. I understand that this attestation is a formal declaration and that knowingly providing false information may result in civil or criminal penalties.

Personal Information

Attestor Name:

Date of Birth:    Passport or ID No.:

Travel Details

Departure Date:    Departure City:    Country:

Return Date (if known):    Destination City:    Country:

Purpose of Travel

Please indicate the primary reason for travel (check all that apply):

Leisure / Vacation
Business / Work
Medical care
Family / Personal emergency
Other (describe):

Health and Exposure Declarations

By checking the boxes below I affirm that, to the best of my knowledge and belief, the statements are true and accurate as of the date of signing:

I am not currently experiencing symptoms of a communicable illness such as fever, cough, shortness of breath, sore throat, loss of taste or smell, or other acute respiratory symptoms.
I have not knowingly had close contact within the past 14 days with any person diagnosed with a communicable illness that could reasonably be transmitted during travel.
If testing is required by destination or carrier, I will comply with testing requirements and will provide truthful test results upon request.
I have disclosed my vaccination status when required by my carrier or destination authority and will provide documentation when requested.

Agreements and Acknowledgments

I understand and agree that I am responsible for complying with all health, travel, quarantine and entry requirements that apply to my travel, including requirements imposed by carriers, airports, health authorities, and destination jurisdictions. I will accept any required testing, quarantine, or isolation measures and will bear any costs associated with compliance, treatment, or extended accommodation arising from illness or required isolation.

I acknowledge that providing false or misleading information on this attestation may result in denial of travel, administrative penalties, civil liability, or criminal prosecution under applicable laws. I further acknowledge that the information provided on this form may be relied upon by my carrier, employer, or governmental authorities for purposes of assessing risk and enforcing public health requirements.

Additional Information

Certification: I certify under penalty of perjury under the laws of the jurisdiction in which this attestation is submitted that the foregoing statements are true and correct to the best of my knowledge.

Optional: Witness or verifying official (name and contact for verification purposes only; witness signature not required here):

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