Kindly note fields marked with * are Required and must be filled before submitting.

Check into the downloads folder of your device for the QR code after submission of this form

Flight Information

Airline Name: *

Flight Number : *

Seat Number : *

Date of Arrival in Kenya: *

Personal Information

First (Given) Name: *

Middle Name:

Last (Family) Name: *

Date of Birth : *

Gender : *

ID/Passport Number: *

Email address * Copy of the QR Code will be sent to this email, ensure it is correct.

Phone Number : * Select the correct country code first.

Home Number:

Business Number:

Permanent Address

Area of Residence: *

Apartment Number: *

County: *

Sub-County: *

Country : *

Postal Code:

Temporary Address

(if you are a visitor, write only the first place where you will be staying)

Hotel(if any):

Number and Street (Separate with comma):

Apartment Number:

County:

Sub-County:

City:

Postal Code:

Emergency Contact information

Next of Kin Full Name:

City:

Country :

Email address

Mobile Phone:

Travel Companions - Family (Only include age if younger than 18 years)

Last (Family) Name:

First (Given Name):

Seat Number:

Age:

Travel Companions - Non-Family (Also include name of group if any)

Last (Family) Name:

First (Given Name):

Group:

MINISTRY OF HEALTH

Local Travelers Health Surveilance Form

Passenger Locator Form