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