Sila masukkan butiran berikut:

Please fill in the following details:

Nama/Name

Nombor Telefon/Mobile Number

No. Kad Pengenalan/IC Number

No. Pasport/Passport No

Umur/Age

Jantina/Gender

Warganegara/Nationality

Pekerjaan/Occupation

Adakah anda / Are you

Akan tiba di Malaysia/Arriving in Malaysia

Akan berlepas dari Malaysia/Departing from Malaysia

Tempat Ketibaan/Port of Arrival

Negara Perlepasan/Country of Departure

No Penerbangan/Kenderaan/Flight/Vessel/Vehicle No

Tempat Duduk/Seat No.(input NA if not applicable)

Tarikh Penerbangan/Vessel/Flight/Vessel Date

Alamat Kuarantin di Malaysia/Quarantine Address in Malaysia

Poskod/Postcode

Negeri/State

Daerah/District

Nama waris/Name of contact in Malaysia

No tel waris/Contact phone number in Malaysia

Sudahkah anda selesai menerima vaksin COVID-19? / Have you completed your COVID-19 vaccination?

Bilakah anda selesai menerima vaksin COVID-19? / When did you complete your COVID-19 vaccination?

Vaksin COVID-19 manakah yang anda terima? / Which COVID-19 vaccine did you receive?

Di manakah anda menerima vaksin COVID-19? / Where did you receive your COVID-19 vaccine?

Dalam 14 hari yang lalu adakah anda mengalami sebarang simptom COVID-19 (demam, batuk, sesak nafas, sakit tekak)?*

In the last 14 days, have you been exhibiting any COVID-19 symptoms (fever, cough, shortness of breath, sore throat)?

Tidak/No

Ya/Yes

Adakah anda berhubung rapat dengan seseorang yang positif COVID-19 dalam tempoh 14 hari yang lepas?*

Have you had close contact with a COVID-19 patient in the last 14 days?

Tidak/No

Ya/Yes

Saya bersetuju untuk didakwa dan dianggap bersalah di bawah Seksyen 15(1) Akta Pencegahan dan Pengawalan Penyakit Berjangkit 1988 (Akta 342) sekiranya terbukti maklumat yang diberikan dalam borang ini adalah tidak benar.* I hereby agree to be charged with offences under Section 15(1) Prevention and Control of Infectious Diseases Act 1988 (Act 342) and shall be deemed guilty if proven that any of the information given in this form is/are incorrect or inaccurate.

Setuju/Agree

Mengikut peraturan Kerajaan Malaysia, semua pelawat hendaklah meyatakan keadaan kesihatan kendiri ketika tiba di negara Malaysia

In accordance with Malaysian Government regulations, all travellers must declare their state of health upon arrival to Malaysia.
Leceh untuk mengisi butiran pendaftaran? Muat turun aplikasi MySejahtera dan gunakan fungsi pengimbas kod QR untuk kunjungan seterusnya!

Tired of filling in your details? Download the MySejahtera Application and use the QR function for your next visit!