MEDICAL DECLARATION FORM

First Name

Last Name

Male / Female

Male Female

Age

Date of Birth

Passport/ID Number *

Arrival Date

Contact Number (Include with country code)

Address

Country

Medical / Surgical history

Medical reports copy (Total size of your reports copy attachments should be less than 6Mb)

Declaration and Data Privacy Consent Form:
By signing this form, I declare that the information I have given is true, correct, and complete. I understand that failure to answer any question or giving a false answer can be penalized in accordance with the law.
I also voluntarily and freely consent to the collection and sharing of the above personal information only in relation to COVID-19 business operation requirements and in accordance with the Data Privacy Act. For any concerns, you may contact info@kurresortlanka.com

I confirm that I have agree with the terms & conditions

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MEDICAL DECLARATION FORM

MEDICAL DECLARATION FORM

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