Covid Visitor | Exquisite Wood

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Covid-19 Declaration Form (Visitors)

Full Name (as stated in ID)

Mobile Phone

Have you been in close contact with a confirmed Covid-19 case in the past 14 days? *

Yes

No

Have you been unwell in the past 14 days? If Yes, please state the medical condition *

Yes

No

Medical Condition

Is anyone at home serving QO or SHN? *

Yes

No

Temperature

How long is your visit here?

I declare and confirm that the information provided in this form is true and not given under any form of duress or undue influence.

Yes

No

This form has been explained to you in whichever language you understand by a representative of Exquisite Wood Pte Ltd

Thanks for submitting!

Exquisite Wood Pte Ltd

Tel: +65 6368 1108

E-mail: sales@exquisitewoodveneer.com

Our wood veneer products are distributed in

SINGAPORE | MALAYSIA | INDONESIA | PHILIPPINES

© 2020. Exquisite Wood Pte Ltd. All Rights Reserved.

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