| Arrival date: | |
| Country of departure: | |
| How are you arriving in Barbados? | |
| Select your Airline: | |
| Flight number: | |
| Departure airport: | |
| Select your Cruise company: | |
| Cruise number: | |
| ACCOMMODATION AND DETAILS OF VISIT |
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| Residential Status: | |
| What is the purpose of your visit? | |
| What type of accommodation are you staying in? | |
| Please describe the accommodation type: | |
| Accommodation address: | |
| Accommodation name: | |
| Accommodation name: | |
| Accommodation name: | |
| Permanent street address in Barbados: | |
| Parish Church (If applicable) | |
| How many nights are you staying in Barbados? | |
| PERSONAL DETAILS |
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| First name: | |
| Last name: | |
| Phone Number: | |
| Enter Email: | |
| Select your gender: | |
| Date of birth: | |
| Country of birth: | |
| Was your passport issued in the same country you were born in? | |
| Select the country your passport was issued from: | |
| Passport number: | |
| Expiry date: | |
| Have you visited any other countries in the last 21 days? | |
| Which countries have you visited in the last 21 days? | |
| HOME ADDRESS INFORMATION |
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| Address: | |
| HEALTH QUESTIONS |
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| 1. Have you had any of the following symptoms over the past seven (7) days? | |
| Have you been on a farm in the last seven (7) days? | |
| FAMILY TRAVEL QUESTONS |
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| I am arriving in Barbados: | |
| FAMILY MEMBER 1 |
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| First name: | |
| Last name: | |
| Gender: | |
| Country of birth: | |
| Date of birth: | |
| Was your passport issued in the same country you were born in? | |
| Select the country your passport was issued from: | |
| Passport number: | |
| Expiry date: | |
| Have you visited any other countries in the last 21 days? | |
| Which countries have you visited in the last 21 days? | |
| FAMILY MEMBER 2 |
|---|
| First name: | |
| Last name: | |
| Gender: | |
| Country of birth: | |
| Date of birth: | |
| Was your passport issued in the same country you were born in? | |
| Select the country your passport was issued from: | |
| Passport number: | |
| Expiry date: | |
| Have you visited any other countries in the last 21 days? | |
| Which countries have you visited in the last 21 days? | |
| FAMILY MEMBER 3 |
|---|
| First name: | |
| Last name: | |
| Gender: | |
| Country of birth: | |
| Date of birth: | |
| Was your passport issued in the same country you were born in? | |
| Select the country your passport was issued from: | |
| Passport number: | |
| Expiry date: | |
| Have you visited any other countries in the last 21 days? | |
| Which countries have you visited in the last 21 days? | |
| FAMILY MEMBER 4 |
|---|
| First name: | |
| Last name: | |
| Gender: | |
| Country of birth: | |
| Date of birth: | |
| Was your passport issued in the same country you were born in? | |
| Select the country your passport was issued from: | |
| Passport number: | |
| Expiry date: | |
| Have you visited any other countries in the last 21 days? | |
| Which countries have you visited in the last 21 days? | |
| CUSTOMS INFORMATION |
|---|
| 1. I am (We are) bringing fruits, plants, cut flowers, vegetables, soil, meat, live animals and organisms, honey, wildlife products, plant material, food, animal products or live birds. | |
| 2. I am (We are) bringing pharmaceuticals. | |
| 3. I am (We are) bringing items that require customs inspection, including controlled substances, biological materials, firearms, ammunition, regulated pyrotechnics, replica firearms, and other items governed by import laws. | |
| 4. I have (We have) commercial merchandise: (e.g. articles for sale, samples used for soliciting orders or goods that are not considered personal effects). | |
| 5. I am (We are) carrying currency or monetary instruments over BDS$ 10,000 or equivalent. | |
| 6. Total number of luggage: | |
