APPLICATION FOR LEAVING THE PLACE OF ISOLATION (FOR ARRIVALS FROM THE COUNTRIES WERE THE SPREAD OF NEW VIRUS VARIANTS HAS BEEN DETECTED)

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

  • *

    Your name, surename

    0
  • *

    I apply for permit leave the isolation place:

    1. to organize the funeral of a close person, transportation of the remains and / or to participate in the funeral ceremony of a close person;

    2. to go to an healthcare institution to collect a nasopharyngeal and throat swab for laboratory testing for COVID-19 or to receive healthcare 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 another place of isolation if the person has to change it for some reason (permission is issued only to go to the place of isolation) 

    1
  • *

    Current address of the place of isolation

    2
  • *

    County of your current place of isolation

    3
  • *

    Your phone number

    4
  • *

    Your email

    5
  • *

    Address of the place of destination

    6
  • *

    Date of departure from the isolation place

    7
  • *

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

    8
  • *

    Duration of the leaving the isolation place

    9
  • *

    Please indicate how will you go to the requested place

    Own transport

    Other

    10
  • *

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

    11
  • *

    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

    12
  • 13
Paskutinė atnaujinimo data: 2021-01-27