NOTIFICATION OF DEPARTURE FROM ISOLATION PLACE

When completing the application, please provide your exact details. Otherwise, the application may not be considered.

Please note that this notification must be completed only by persons arriving / returning from countries from which enhanced controls are applied in accordance with the List of Affected Countries, that is updated every week and can be found here. If such countries are not included in this list, this request does not need to be completed.

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    Your name, surename

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    I report that I am leaving the place of isolation for one of the following reasons:

    1. to organize the funeral of a close person, the transportation of the remains and / or to attend a funeral ceremony / burial of a close person or to visit terminally ill patients;

    2.  go to the healthcare institution to take samples from the nasopharynx and pharynx for laboratory testing for COVID-19 disease (coronavirus infection) or for serological testing for SARS-CoV-2 antibodies or go to a medical facility for health care services; (when going to the healthcare institutions for emergency services, permission from the NPHC or information of the NPHC is not required);

    3. to go to the place necessary for the administration of legal affairs;

    4. to take a person who is unable to take care of himself / herself to an personal healthcare institution to receive health care services;

    5. to go to governmental institutions, establishments and organizations at their invitation;

    6. high-performance athletes, high-performance sports professionals, high-performance sports instructors, sports medical personnel may attend high-performance sports exercises, training camps, competitions and institutions or establishments related to their sports activities.

    7. travellers who have to go for the second dose of COVID-19 vaccine as per appointment
     

    8. crew members employed in companies engaged in international commercial transportation or who carry out international commercial transportation by all types of vehicles to go for any doze of vaccine as per appointment;
     

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    Current address of the place of isolation

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    County of your current place of isolation

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    Your phone number

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    Your email

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    Address of the place of destination

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    Date of departure from the isolation place

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    Time of departure from the isolation place (hours, minutes)

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    Duration of the leaving the isolation place

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    Please indicate how will you go to the requested place

    Own transport

    Other

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    I confirm that I do not feel any symptoms of COVID-19 (fever, cough, shortness of breath) on the day of application

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    I understand that the permit only allows me to go to the address specified in the permit for the purpose specified in the permit, but does not relieve me of my obligations taken by signing the Agreement to self-isolate,  and of my obligations to continue to comply with self-isolation rules, and I agree to wear protection devices covering nose and mouth (face mask, respirator or other devices; wear disposable gloves when touching objects; avoid direct physical contact, maintain the set safety distance; strictly observe personal hygiene requirements (hand hygiene, coughing, sneezing etiquette)

    I agree

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Paskutinė atnaujinimo data: 2021-10-27