iGift Company Limited - Health Declaratoin Form

因應疫情考慮，來訪香港公司, 需申報健康狀況并佩戴口罩, 及恕不招待37.3度以上的客戶，請見諒
（In consideration of the epidemic situation, when visiting iGift, pls declare your health condition and wear a mask, and sorry that whoever 's temperature above 37.3 degrees or without wearing mask will not be served.）

Name *
First Last
Phone *
你是否過去 14 日內曾與任何確診人士或懷疑確診人士(無論在香港或海外)有密切接觸 ?
（Have you had close contact with any confirmed or suspected confirmed person (whether in Hong Kong or overseas) in the past 14 days?） *

幫助
請選擇貨品交收地點。
是（YES）否(NO)
你是否曾接受2019冠狀病毒測試，並且結果為陽性？
（Have you ever been tested for the 2019 coronavirus and the result was positive?） *

幫助
請選擇貨品交收地點。
無測試過（no test）有測試過陽性（tested , +ve）有測試過陰性（tested , -ve）
如有以下徵狀，請加上剔
（If you have the following symptoms, please tick ） *
發燒（Fever）咳嗽（Cough）氣促（Gasp for breath）呼吸困難（Breath difficulty）咽喉痛（Sore throat）無（Nil）
本人申報、聲明及同意如下:
本人聲明據本人所知及所信，以上資料均屬正確無誤，本司會存底60天, 如沒有其他問題, 資料會銷毀
本人在過去 14 日內並無離開香港。
本人並未曾與在過去 14 日內曾離開香港的任何人士有密切接觸，尤其是家人、家庭傭工及司機。
確定請簽署
（I declare and agree as follows:
I declare that as far as I know and believe, the above information is correct. Our company will keep it for 60 days. If there are no other issues, the information will be destroyed
1. I have not left Hong Kong in the past 14 days.
2. I have not had close contact with anyone who has left Hong Kong in the past 14 days, especially family members, domestic helpers and drivers.
Please sign if you are sure ） *

幫助
Date

幫助
請填寫交貨日期，分別按月日年順序添加。
/ MM / DD YYYY