Gandhinagar Municipal Corporation,
Gujarat
NOVEL CORONA SELF DECLARATION FORM
Name
*
Address
*
Mobile No.
*
Travel Type
*
Select Travel Type
Foreign Countries
From Other State/UT
From Other District
Travel City/District
*
Date of Arrival in GMC Area
*
Mode of Travel
*
Select Mode of Travel
Train
Bus
By Air
Private Transport
Others
PassportNo
Suffering from fever
*
Yes
No
Have Cough
*
Yes
No
Difficulty in breathing
*
Yes
No
Other Details
Enter Image Text
*