Day 2 International Arrivals

 

1. Please enter your Full Name including any middle names: *

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2. Please indicate your gender: *

 

3. Please enter your Date of Birth: *

   DD/MM/YYYY 
 
 

4. Please enter your NHS number (if known):

 

5. Please describe your ethnicity: *

 

6. Please state below the date and type of any Covid-19 vaccines you have received to date.
(Please leave blank if you have not yet received your first dose of a Covid-19 vaccine)

 

7. Please enter your Passport or ID card number: *

 

8. Please enter your full Postal Address: *

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*
*
 

9. Please enter the date of your arrival to the UK:

   DD/MM/YYYY 
 
 

10. Please state below any countries that you transited through while travelling back to the UK? (Please write NONE if not applicable) *

 

11. Please state the time of your arrival in the UK?

 HHMM
 

12. Which country or territory were you travelling from when you arrived back to the UK? *

 

13. Please state the date on which you departed from (or last transited through) a country outside of the UK? *

   DD/MM/YYYY 
 
 

14. Please state your coach number, flight number or vessel name (as appropriate): *

 

15. Please enter your Email Address: *

 

16. Please enter your Contact Details: *

*
 

17. Do you give your Consent for our service to communicate with you by email? *

 

18. Please tick to indicate which type of email communication you consent to receiving?

 

19. Do you give your Consent for our service to communicate with you by SMS? *

 

20. Our Terms and Conditions can be viewed by clicking on the link below:

Click to view Terms and Conditions

Please tick the box below to confirm that you have read and agree to our Terms and Conditions:

 

21. Please click on the link below to view our Privacy Policy:

Privacy Policy

Please tick the box below to confirm that you have read and consent to our Privacy Policy:

 

22. As part of the our Covid-19 testing service we are legally obliged, on request, to share data submitted on this form with Public Health England or, if approached, with the Police (in exceptional circumstances where they need to confirm a quarantine period). Please tick the box below to indicate you understand this and consent: