Given Name (as it appears on your passport) *
Last Name (as it appears on your passport) *
Email Address *
Have you or any of your household been in close contact with a COVID positive case in the past one month?
Have you displayed any symptoms of COVID in the past week including:
• Runny nose
• Sore Throat
• Altered taste or sense of smell
Do you have a recent negative COVID test result less than 7 days from your scheduled departure for the South Pacific?
(select)YesNoSubmitted but result pendingWill Do swab test today
Do you confirm your answers to be truthful being aware that Under the Customs Act 1901 there are severe penalties for making a false or misleading statement? *
DAISI is a registered charity with the Australian Charities and Not for-profits Commission (ACNC)
DAISI is committed to adhering to the Australian Council For International Development (ACFID) Code of Conduct.
Doctors Assisting In South Pacific Islands Pty Ltd (DAISI)
PO Box 679, Crows Nest, NSW 1585.
shop 1, 38 Pacific Hwy, St Leonard’s NSW 2065
© DAISI 2015 ABN 72 642 539 080