Self Declaration Form
Please Fill up the Form below.
On successfull Submission you can download your Form and show it at the Point of Entry
Aircraft / Train / Car No.
Name
Mobile No.
Destination State
Select...
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh (UT)
Chhattisgarh
Dadra and Nagar Haveli (UT)
Daman and Diu (UT)
Delhi (NCT)
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep (UT)
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry (UT)
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal
Destination District
Select...
Transit Passenger(Inter State)?
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Yes
No
Residential address
Residential proof
Identity proof
I hereby declare that
Please select whichever is applicable
I have a Negative COVID-19 test report by RT-PCR/ Truenat/ CBNAAT, with the test done not earlier than 72(seventy two) hours prior to entry into Nagaland and I shall self isolate/remain in quarantine, for 7 (seven) days.
I do not have a Negative COVID-19 test report and I shall self/isolate/quarantine for 7 (seven) days.
I am a transit passenger (inter-state) to and I shall proceed to my destination without halting anywhere in Nagaland, and I am adhering to the testing guidelines of State.
The information provided by me is true and correct to the best of my knowledge and belief. In the event of any information given is found to be false or incorrect, I shall be responsible for the consequences.
I am aware that in case of violation of the Government instructions, or the undertaking given by me, I shall be liable to be prosecuted as per law.
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This is a system generated Self Declaration Form and does not require a signature.
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