Passenger Pre-boarding Health Declaration & Screening Form

1 Personal Information

Family Name *

First Name *

Middle Name

Gender *

Male

Female

Do you hold a Diplomatic Passport *

Yes

Passport Number *

Confirm Passport Number *

Select Nationality *

Email *

Confirm Email Address *

Confirm Email Address *
Kindly ensure your email address is correct as your QR Code will be sent there

p10

Main Phone Number *

Phone Number to reach you on *
Note: Only 11-digit Nigerian phone number is acceptable e.g 08022233355 (Personal, hotel, agent or relative)

Alternative Phone Number

Alternative Phone Number
Note: Only 11-digit Nigerian phone number is acceptable (Personal, hotel, agent or relative)

Date of Birth *

E.g., 10 Aug 2022

Date of Birth *

Flight No *

Arrival Location *

Arrival Date *

E.g., 10 Aug 2022

Arrival Date *

Country of First Departure *

Select Country of Transit

Country of Transit

Select Country of Residence *

Country of Residence *

Residential Address *

p23

Passport Data Page

Upload your passport data page CLEARLY showing your Date of Birth and Diplomatic status (if Diplomat)*
False claims may lead to arrest and prosecution in court
Files must be less than 5 MB.
Allowed file types: jpg jpeg png.

2 Countries Visited in the Last 21 Days

Countries Visited In The Last 21 Days *

Countries Visited In The Last 21 Days * Click the field above and select one or more countries

3 Enter 1 or more Destinations in Nigeria (For The Next 21 Days)

Destination in Nigeria *		Order
	pc1 Enter address * Enter address * Destination Phone Number * Phone Number * pc2 State in Nigeria * State in Nigeria * City * City * pc3 Resident * Yes No Duration of Stay *	Weight for row 1

4 Emergency Contact in Nigeria or Next of kin

Contact Details

Full Name *

Address *

Emergency Phone Number *

Phone Number * Note: Only 11-digit Nigerian phone number is acceptable and must be different from Main Phone Number supplied earlier

5 In the last 21 days did you have any of the following

Please tick Yes or No

Fever *

Yes

Cough *

Yes

Difficulty breathing *

Yes

Generally feeling unwell *

Yes

Sneezing *

Yes

Other Symptoms of Flu or Cold *

Yes

6 In The Last 21 Days Have You Had Contact With Anyone Who Had The Following?

Please tick Yes or No

Fever *

Yes

Cough *

Yes

Difficulty in breathing *

Yes

Generally feeling unwell? *

Yes

Sneezing *

Yes

Other Symptoms of Flu or Cold *

Yes

Visited a funeral in the last 21 days *

Yes

7 Have You Taken Any of The Following Medications In The Last 24 Hours?

Please tick Yes or No

Antibiotics *

Yes

Flu Or ‘Common’ Cold Medications *

Yes

Antiviral Drugs *

Yes

Paracetamol, Ibuprofen, Or Other Pain relieving Medications *

Yes

8 COVID 19 Test

p24

Vaccination Status

Select Vaccination status *
As applicable, presentation of proof of vaccination must be done on arrival

Vaccination Proof *

Upload your proof of vaccination CLEARLY showing your Vaccination Status*
False claims bring on consequences of lying to Immigration
Files must be less than 5 MB.
Allowed file types: jpg jpeg png pdf.

Pre-Boarding COVID Test DetailsNote: You are required to provide details of a COVID test taken at least 48 hours prior to departure and take a subsequent day 2 and day 7 test depending on your proven vaccination status

p15

Test Result

Select Test Result *

Test Date

E.g., 10 Aug 2022

Test Date *

p16

Test Lab Name

Test Lab Name *

Test Lab Address

Test Lab Address *

p17

Test Lab Phone Number

Test Lab Phone Number *

Test Country

Test Country *

p18

Test Institution City

Test Institution City *

p19

Result PDF

Upload Result PDF *
Files must be less than 10 MB.
Allowed file types: pdf jpg jpeg png.

Post-Arrival COVID Test Details

Note: Select a laboratory or sample collection center that is nearest to where you will be observing the 7 days self isolation (if not fully vaccinated) to ease your process of carrying out the mandatory test(s).

Unvaccinated & Partially Vaccinated people would have to pay and do 2 tests, for Day 2 and Day 7

p20

Where will you be on Day 2

Where Will You Be On Day 2 *

Preferred Test Center

Select preferred test center *

p21

Mode of Payment

Select Mode of Payment *
IMPORTANT: Bank Transfer option is NOT AVAILABLE for those that selected Lagos above

Preferred Payment Currency

Select Preferred Payment Currency *

p22

Pdisc2

Please Note:
The following are mandatory on the bearer:
(a) Fully vaccinated passengers:

Post arrival test not required

(b) Unvaccinated or partially vaccinated passengers:

To self isolate for 7 days
To take repeat tests on days 2 and 7 post arrival.

Failure to comply with the above will lead to suspension of passport for 6 months or cancellation of visa for non-Nigerians.

Accept the above instruction *

Agree to our terms and conditions *

Click here to download

Agree to our privacy policy *

Click here to download

VISITED INDIA, BRAZIL AND TURKEY WITHIN FOURTEEN (14) DAYS PRECEEDING TRAVEL TO NIGERIA?

Information for Travelers who have visited India, Brazil and Turkey within Fourteen (14) days preceding travel to Nigeria (Excluding Transit Travelers)

Nigerians and those with permanent resident permit who visited Brazil, India or Turkey within fourteen (14) days preceding travel to Nigeria shall
1. Undergo seven (7) days of mandatory quarantine in a Government approved facility at the point-of-entry city and at cost to traveler
2. Pay and take a COVID-19 PCR test within 24 hours of arrival and take another repeat COVID-19 PCR test on Day-7 of quarantine
Penalities for non-compliance apply

Bank Details / Instructions

Bank details for transfer payment can be found below. More information would be sent to your email

Sterling Bank
Account Name: COVID Test Collection NITP
Account Number:0085651527

Please note that bank transfer could take up to 24hrs for confirmation

Also, check your email after submission for your INVOICE NUMBER and ensure you include in payment narration when making the bank transfer

Passenger Pre-boarding Health Declaration & Screening Form

Vertical Tabs