HEALTH DECLARATION FORM
Important Reminder:


Kindly complete this Health Declaration Form honestly.

Please e mail the copy of valid id at:

sales@oriental-zen-suites.com

Accomplish and send the duly filled up form before actual arrival at Oriental Zen Suites for contact tracing in
accordance to Covid-19 Protocol.
First Name  :
Middle Name :
Last Name  :
Date of Check-in / Arrival :
Civil Status   :
Male / Female
Married / Single
Residential Address :
House Number
Street
District
Municipality / City
Contact Number  :
E-mail Address :
Date of Birth  :
Occupation   :
Purpose of Travel  :

Oriental Zen Suites

Guest Health Condition and Body Temperature Check Policy:

I’m willing to take a body temperature check upon entering the building.

And I completely understand that Oriental Zen Suites will  not permit me to enter the
building premises if I have now and on the date of arrival the following symptoms of
COVID-19 listed below:
Body Temperature
upon filling up this
form:
Yes / No
Shortness of Breath
Loss of Sense of Taste or Smell
Dry Cough
Runny Nose
Sore Throat
Is the Purpose of Stay for
Quarantine?
Yes / No
Do you have travel history for
the last 14 days? :
Yes / No
If yes,  please fill up below
the necessary details:
Arrival Date  :
Flight No. :
Port of Origin :
Countries /
Municipalites Visited
for the last 14 days  :
Health and Safety-Related Questions :
Have you been in contact
with  anyone  in the last 14
days who is experiencing
this COVID-19 symptoms?
Yes / No
Have you been in contact
with anyone who has since
tested positive for
Covid-19?
Yes  /  No
I fully   understand,   read,    and    completed   this questionnaire      truthfully.    I   agree   
that   this constitutes     full    disclosure        and      that    it  supersedes   any   previous   
verbal    or   written disclosures. I understand  that  this  document is to provide the health
condition and experience of guest before  and during the visit to Oriental Zen Suites.
Data Privacy Notice:

Oriental Zen Suites, in line with Republic Act 10173 or the Data Privacy Act of 2012, is committed to protect  and  
secure  personal  information  obtained in the performance of duties. Oriental  Zen Suites  collects  the  above  personal
information  relevant  in  the  advancement of protocols and precautionary measures against COVID-19 Acute
Respiratory Disease.. The collected information will be  kept  /  stored  and accessed  only by authorized personnel and
will not be shared wit any outside  parties  unless  the  disclosure  is  required  by, or in compliance with applicable laws
and regulations.