Zens Medical Centre - Namaka

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Personal Details

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First Name

Last Name

Date of Birth

Passport No.

Address in Fiji (hotel or local residential)

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Nationality (As per passport)

Sex

Mobile Number

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First Name	Last Name	DOB	Nationality	Sex	Passport No.

Secondary Contact in Fiji

Contact details of the person you will be staying with in Fiji:

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Staying at a CFC Hotel/Resort

Not staying at a CFC Hotel/Resort

Name of Hotel/Resort

Check-out Date

Full Name

Mobile Number

Check-in Date

Exact Residential Address

Travel and Test Details (Bookings must be made within 72hr slot)

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Country of Departure

Arrival into Fiji

Select your test date at the Facility

Flight Number

Departure from Fiji

Item	Price	Qty	Line Total
ZENS MEDICAL CENTRE (ZMC) PTE LTD - RAT	$38	1	$38
Total			$38

Terms & Conditions

I agree that should I fail to show up for my COVID-19 test, I may be subject to legal implications, including, but not limited to a fine not exceeding FJ$1,000

I agree to grant permission to have the Principal Contact listed in this submission

I agree to abide by Fiji's Entry Conditions and have read, understood, and agree to the Terms and Conditions

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Terms & Conditions

I agree that should I fail to show up for my COVID-19 test, I may be subject to legal implications, including, but not limited to a fine not exceeding FJ$1,000

By clicking on the following, I, hereby solemnly declare to adhere to all the terms and conditions. I confirm that the information provided is true and correct to the best of my knowledge, and if proven otherwise, I acknowledge that I will be liable for penalties as stipulated under the False Information Act 2016. Any person who fails to comply with the terms and conditions herein commits an offense and is liable on conviction to a fine of $1,000 under the Public Health Act 1935.

Zens Medical Centre - Namaka

Personal Details

Secondary Contact in Fiji

Travel and Test Details (Bookings must be made within 72hr slot)

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