To prevent the spread of COVID-19 and reduce the risk of exposure to our stakeholders, we are conducting a simple screening questionnaire. Your cooperation is important to help us take precautionary measures to protect you and everyone in these premises.

Health Screening Declaration Form

Step 1 of 3

Provide Visitor Information

Enter Your Full Name
Provide your Mobile Number.
Provide either your NRIC or Passport or Co. No
(Required for car / motorcycle only)
Enter Your Email
Enter Name of host / officer-in-charge
Enter Meeting venue

Health Declaration

In the last 14 days have you: Yes No
1 Returned from an outstation trip?
If ‘Yes’, please provide the name of place:
2 Attended any gatherings identified as clusters by MOH?
3 Been identified as a close contact to a confirmed Covid-19 case?
4 Any of your household identified as a close contact?
5 Are you currently experiencing any of the symptoms below:
• Fever
• Cough
• Sore throat
• Runny nose
• Shortness of breath

CONFIRM AND SUBMIT

Nearly Finished!

By submitting this form I hereby agree that the International Centre for Education in Islamic Finance (INCEIF) may collect, obtain, store and process the personal data provided in this form for the purpose of conducting a health screening, and if required, for contact tracing purposes hereafter.

I understand that INCEIF may deny my entry to its campus based on the information provided above.

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