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Health & Legal Concerns Self-Declaration

This self-declaration form requires candidates to confirm their health status regarding COVID-19 symptoms and exposure. Candidates must declare if they have symptoms such as cough or fever and certify that they have not tested positive for the virus. The form also notes the candidate's awareness of safety measures in place and the requirement to fill it out due to the absence of the Aarogya Setu app.

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ishky manohar
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91 views1 page

Health & Legal Concerns Self-Declaration

This self-declaration form requires candidates to confirm their health status regarding COVID-19 symptoms and exposure. Candidates must declare if they have symptoms such as cough or fever and certify that they have not tested positive for the virus. The form also notes the candidate's awareness of safety measures in place and the requirement to fill it out due to the absence of the Aarogya Setu app.

Uploaded by

ishky manohar
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Self-Declaration

We are concerned about your health, safety & hygiene. In the interest of your well-being and that of
everyone at the venue, you are requested to declare if you have any of the below listed symptoms
by using a (Yes, I have) or  (No, I do not have).

Cough

Fever

Sore Throat / Runny Nose

Breathing Problem

Body Ache

 I have NOT been in close contact with a person suffering from Covid 19 and am NOT under
mandatory quarantine

 I may be subject to legal provision/ action as applicable for hiding any facts on Covid 19 infections
related to me and causing health hazard to others.

 I am aware Bank has taken measures as per advisories of Government of India related to norms
of social distancing and sanitization at the document verification centre.

 I am asked to fill this Self-Declaration, since I do not have “Aarogya Setu” App on my mobile
phone.

 I am certifying that I have NOT tested Positive for the Coronavirus or identified as a potential
carrier of the COVID-19 virus.

Candidate Name : ________________________________________________

Candidate Roll No : ________________________________________________

Signature of the Candidate

Date:

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