Annexure-II UNDERTAKING – revised

To The Consulate General of India 365 Bloor Street East, Suite # 700 Toronto M4W 3L4

Subject: Consent Form for evacuation from Toronto

I, undersigned, with following personal particulars –

Name as written in passport :

Date of birth and age : DOB: Age :

Gender (Male / Female ) : Flight no. & Date ::

Passport Number : Nationality :

OCI no. : Visa Number: :

Email ID :

Status and Compelling reasons (Write a; b; c; d; e; f;g; h relevant to your category

Status: [a.Student; b.Professional; c.worker; d.Visitor/Tourist; e.Deportee; f.Others; (Canadian with OCI/visa); G. crew, fisherman, seamen]

Compelling Reason: a. deportation; b. non-permanent resident, status expired; c. medical emergency of self or family members in India; d. Pregnant women/Elderly; e. Due to Death in family; f. Tourist/Visitor; g. Student; h. others.

Address in India :

Domicile State /UT in India :

Contact number abroad :

Contact number in India :

confirm my willingness to return to India on the special flight and solemnly affirm as under –

- That I confirm my readiness to follow all instructions given by the officials of the Government of India/Consulate/High Commission of India/Aircraft crew/medical personnel;

- That I have submitted self-reporting/declaration form on the online portal (www.newdelhiairport.in). [This is a

requirement w.e.f 11 August 2020 and should be preferrably done 72 hours before scheduled departure; Passenger will receive acknowledgement email with unique reference number along with the copy of the submitted form].

- That I undertake to undergo mandatory quarantine of 14 days - (Revised now to 7 days of institutional quarantine

at their own cost followed by 7 days of home quarantine with self-monitoring of health, as per the new guidelines)

- That I understand Home Quarantine of 14 days can be allowed by the concerned authorities for certain categories [Please note that only for compelling reasons/cases of human distress such as pregnancy, death in family, serious illness

and parent(s) with children of the age of 10 years or below, home quarantine may be permitted by concerned authorities in India, provided they apply on the online portal – www.newdelhiairport.in – by submitting a COVID19-negative report through RT-PCR test done 96 hours prior to undertaking journey. The online application should be made at least 72 hours before boarding]; Each passenger shall also submit a declaration with respect to authenticity of the report and will be liable to prosecution, if found otherwise. The test report could also be produced upon arrival at the point of entry airport in India];

- That I agree to be quarantined in one of the facilities in Delhi, Delhi NCR or Haryana; or Bhiwadi or Chandigarh or other States as per my destination and protocols framed by the Government of India /State Government; and will not insist on returning to my State of Domicile, (if quarantined in Delhi) before completing the mandatory period of quarantine; and that after the quarantine period is over, I will return to my home or State of Domicile , either by making my own arrangements or through the arrangements facilitated by the Resident Commissioner/ nodal Officer of the concerned State. [Please note that travellers coming from abroad are not allowed to mix with domestic passengers].

2. I fully understand that while travelling in the special repatriation flight, I may be inadvertently exposed to any infection, including COVID-19 virus, and having fully understood the risk to my person, I voluntarily give consent to travel to India in the special repatriation flight. I undertake and agree that neither I nor my heirs nor my executors nor administrators will hold responsible Union of India, any official of Union of India or staff of Airline or any of my fellow passengers for any injury to me (including death) or loss of property due to any accidental exposure.

(Signature of Passenger)