Application for a permit to leave the place of isolation

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    Your name and lastname

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    The reason for the request to leave the place of isolation is the need

    to go to a place necessary for work, study or other business or to receive health care services (only for persons with contact who have returned from abroad)

    to leave the Republic of Lithuania before the expiry of the 14-day isolation period (for foreigners and citizens of the Republic of Lithuania living or working abroad)

     

    to organize the funeral of a close person, transportation of corpses and / or to participate in the armor ceremony / funeral of a close person (only for persons in contact)

    to go to a mobile laboratory for COVID-19 infection test

    to organize and whether to participate in my own or a loved one's wedding, christening or anniversary (only for persons in contact who have returned from abroad)

    to change the place of isolation

    to go to state institutions for submission and (or) receipt of work-related documents or other work-related issues (for international freight carriers)

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    Name of the company, the education or medical institution

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    Address of your isolation place 

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    County of your isolation place

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    Your phone number

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    Your e-mail address

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    Destination address

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    Date of the leaving the isolation place

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    Duration of the leaving the isolation place

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    How are you going to go to the specified location?

    by transport provided by the employer

    other

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    I certify that I do not experience any symptoms of COVID-19 (fever, cough, dyspnoea) on the day of application.

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    I understand that the permit only entitles me to visit the address specified in the permit for the reasons specified in the permit, but does not relieve me of my obligation to continue to comply with the self-isolation rules, and I agree: to wear a medical mask or other device to cover the nose and mouth; to wear disposable gloves when touching objects; to avoid direct contact, keep a safe distance (2 meters); strictly follow personal hygiene requirements (hand hygiene, coughing, sneezing etiquette).

    I agree

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Paskutinė atnaujinimo data: 2020-08-07