Health declaration form

VESSEL: YACHT ANNABELLA
VESSEL'S PORT OF REGISTRY/NO OF REGISTRY: PIRAEUS, NP5287

DATE (day/month/year) AND TIME OF INITIAL EMBARKATION

PORT OF INITIAL EMBARKATION

Your Email

Contact telephone numbers for the next 14 days after disembarkation:

Full name as shown in the Identification Card/Passport:

Your father's name:

Full names including father's name of all children travelling with you who are under 18 years old (one per line):

PLEASE ANSWER THE FOLLOWING QUESTIONS

Within the past 14 days

1. Have you or has any person listed above, presented sudden onset of symptoms of fever or cough or difficulty in breathingsudden onset of anosmia, ageusia or dysgeusia?
YESNO

2. Have you, or has any person listed above, had close contact with anyone diagnosed as having coronavirus COVID-19?
YESNO

3. Have you, or has any person listed above, provided care for someone with COVID-19 or worked with a health care worker infected with COVID-19?
YESNO

4. Have you, or has any person listed above, visited or stayed in close proximity to anyone with COVID-19?
YESNO

5. Have you, or has any person listed above, worked in close proximity to or shared the same classroom environment with someone with COVID-19?
YESNO

6. Have you, or has any person listed above, travelled with a patient with COVID-19 in any kind of conveyance?
YESNO

7. Have you, or has any person listed above, lived in the same household as a patient with COVID-19?
YESNO

Test results and vaccination

8. Have you been tested for COVID-19 with a molecular method (PCR) within the past 72 hours?
NO PENDING RESULTS * POSITIVE NEGATIVE

9. Have you performed, this day or the day before, a rapid test fo rCOVID-19?
NO * POSITIVE NEGATIVE

10. Have you been vaccinated with all the necessary doses for COVID-19?
NO YES

* Embarkation onboard the ship is prohibited only if there is an affirmative answer