Please ENABLE YOUR JAVASCRIPT to make your experience on this page interactive.
icon

Camiguin Health Declaration Form

(Kindly fill out all the information needed and do not leave any box unmarked. Travelers are required to complete a Health Declaration Form.)

* - Required to fill-up.

Personal Information
*
*
*
*
*
*
*
*
*
Destination Address
* * *
Travel Details to Province of Camiguin

*
*
*
Exposure History

Clinical Information

*
*
*

Upload the Coordination Letter for Tourist (max file size 10MB, allowed extensions: *.jpg, *.png, *.pdf)*
Upload your Confirmed Booking, Invitation, or Confirmation of Stay (max file size 10MB, allowed extensions: *.jpg, *.png, *.pdf)*
Upload your RTPCR Result. (max file size 10MB, allowed extensions: *.jpg, *.png, *.pdf)*
Upload your Vaccination ID/Card picture. (max file size 10MB, allowed extensions: *.jpg, *.png, *.pdf)*

* I hereby authorized the Province of Camiguin, to collect and process the above information for the purpose of effecting control of the COVID-19 infection. I understand that my personal information is protected by RA 10173, Data Privacy Act of 2012 and that I am required by RA 11449, Bayanihan to Heal as One Act, to provide TRUTHFUL information.

Camiguin Health Declaration Form
*
*

{{ invalid_credentials }}

no CCQR yet? Register here

Submit