HAVE YOU EVER USED A PASSPORT UNDER DIFFERENT NAME TO ENTER MALAYSIA?*IF YES PLEASE STATE你曾经使用护照不同的名称入马来西亚? *如果是请注明:NO
DEPARTURE CARE(出境卡)
FULL NAME (AS APPEARS IN PASSPORT)姓名:
PASSPORT NO护照号:
NATIONALITY国籍:
NOTICE 公告
PLEASE RETAIN THIS DEPARTURE CARE IN THE PASSPORT 请保留此离境援外护照
FOR OFFICIAL USE政府使用
CUSTOMS DECLARATION(海关申报)
EACH TRAVELLER OF RESPONSIBLE FAMILY MEMBER MUST PROVIDE THE FOLLOWING INFORMATION(ONLY ONE DECLARATION PER FAMILY IS REQUIRED)每个旅行者的负责任的家庭成员必须提供下列资料(只能选择其中一项宣言每个家庭为必填项)
FULL NAME (AS APPEARS IN PASSPORT)姓名:
PASSPORT NO护照号:
NUMBER OF FAMILY MEMBERS TRAVELING TOGETHER同行家庭人员数量:
PLEASE TICK() IN THE RELEVANT BOX AFTER READING THE NOTICE ON PAGE 6在方框内打勾并读第6页公告:
GOODS TO DECLARE(申报)PLEASE DECLARE ON PAGE 6 AND PROCCEED TO CUSTOMS EXAMINATION LANE请申报第6页及PROCCEED海关检验巷
NOTHING TO DECLARE(不申报)PLEASE PRCCEED TO GREEN LANE请通过绿色巷
I HAVE READ THE NOTICE AND CERTIFY THAT THIS DECLARATION IS TRUE我已经阅读了公告,并证明,我说的是真的。
SIGNATURE签名 DATE日期
***背面***
PLEASE DECLARE ALL GOODS IN EXCESS OF THE DUTY EXEMPTIONS请申报所有货品超过免税待遇:
货品描述/数量/多少钱
PLANT QUARANTINE DECLARATION植物检疫宣言(全填NO)
Have you been to Africa Central or South America during the last 30 days?你去过非洲或南美洲中部在过去的30天?
and jor
Are you carrying any plant materi看不清楚。填NO
HEALTH QUARANTINE DECLARATION 卫生检疫宣言
都填NO
CURRENCY DECLARATION 货币宣言
(可不填)
------------------------------------
HEALTH DECLARATION FORM (健康申报表)
All persons entering Malaysia shall furnish information as required in this form 所有进入马来西亚的人应提供资料的要求此表
1 Have you been tu any area or country with local transmission of influenza A(H1N1)as indicated by the world Health Organization over the past?days? 1你有没有涂任何地区或国家与地方的传播流行性感冒( H1N1病毒)所示由世界卫生组织过去?天?
No
2 if Yes,Please specify the said area/countries如果有,请具体说,地区/国家:
3.Date of departure from the said countries离开日期从上述国家:
4.Have you had any of the following symptoms over the past 7 days?。你有下列任何一种症状,在过去7天内的? no
High fever(more than 38度 or more than 100.4度f 发高烧(超过38度或超过100.4度f NO
Cough/Difficulty in breathing or shortness of breath 咳嗽/呼吸困难或呼吸急促 No
Others/(please specify)其他/ (请注明)
5.Have you been in contact with aperson suspected to have Influenza A(H1N1) 5.你有接触过怀疑流行性感冒的人吗?( H1N1病毒) no
6.if the answer is yes to either of the question above,please report to the Health Quarantine Station 如果答案是肯定的任何问题,请向卫生检疫站
FULL NAME (AS APPEARS IN PASSPORT)姓名:
PASSPORT NO护照号:
DATE OF EXPIRY (DD-MM-YYYY)护照有效期:
GENDERN性别:MALE男 FEMALE女
PLACE OF ISSUE(护照签发地):
NATIONALITY国籍:
DATE OF BIRTH(DD-MM-YYYY)生日:
PLACE OF BIRTH出生地:
CITY OF RESIDENCE居住城市:
COUNTRY OF RESIDENCE居住国家:
LAST COUNTRY OF EMBARKATION上一个入境国家:
FLGHT NO /VEHICLE REGN.NO/VESSEL NAME/TRAIN NAME航班号等:
FIRST VISIT TO MALAYSIA*第一次来马来西亚吗?:
TRAVELLING ON PACKAGE TOUR*随团吗:
OCCUPATION*职业/TECHNICAL专业/技术 Sales/Clenical销售
PURPOSE OF VISIT*访问目的
ACCOMMODATION DURING STAY*在这期间住宿情况/MOTEL
HAVE YOU EVER USED A PASSPORT UNDER DIFFERENT NAME TO ENTER MALAYSIA?*IF YES PLEASE STATE你曾经使用护照不同的名称入马来西亚? *如果是请注明:NO
DEPARTURE CARE(出境卡)
FULL NAME (AS APPEARS IN PASSPORT)姓名:
PASSPORT NO护照号:
NATIONALITY国籍:
NOTICE 公告
PLEASE RETAIN THIS DEPARTURE CARE IN THE PASSPORT 请保留此离境援外护照
FOR OFFICIAL USE政府使用
CUSTOMS DECLARATION(海关申报)
EACH TRAVELLER OF RESPONSIBLE FAMILY MEMBER MUST PROVIDE THE FOLLOWING INFORMATION(ONLY ONE DECLARATION PER FAMILY IS REQUIRED)每个旅行者的负责任的家庭成员必须提供下列资料(只能选择其中一项宣言每个家庭为必填项)
FULL NAME (AS APPEARS IN PASSPORT)姓名:
PASSPORT NO护照号:
NUMBER OF FAMILY MEMBERS TRAVELING TOGETHER同行家庭人员数量:
PLEASE TICK() IN THE RELEVANT BOX AFTER READING THE NOTICE ON PAGE 6在方框内打勾并读第6页公告:
GOODS TO DECLARE(申报)PLEASE DECLARE ON PAGE 6 AND PROCCEED TO CUSTOMS EXAMINATION LANE请申报第6页及PROCCEED海关检验巷
NOTHING TO DECLARE(不申报)PLEASE PRCCEED TO GREEN LANE请通过绿色巷
I HAVE READ THE NOTICE AND CERTIFY THAT THIS DECLARATION IS TRUE我已经阅读了公告,并证明,我说的是真的。
SIGNATURE签名 DATE日期
***背面***
PLEASE DECLARE ALL GOODS IN EXCESS OF THE DUTY EXEMPTIONS请申报所有货品超过免税待遇:
货品描述/数量/多少钱
PLANT QUARANTINE DECLARATION植物检疫宣言(全填NO)
Have you been to Africa Central or South America during the last 30 days?你去过非洲或南美洲中部在过去的30天?
and jor
Are you carrying any plant materi看不清楚。填NO
HEALTH QUARANTINE DECLARATION 卫生检疫宣言
都填NO
CURRENCY DECLARATION 货币宣言
(可不填)
------------------------------------
HEALTH DECLARATION FORM (健康申报表)
All persons entering Malaysia shall furnish information as required in this form 所有进入马来西亚的人应提供资料的要求此表
PART A (General)
Full name 全名
Gender 性别
Age出生日期
Passport Number护照号
Nationality国籍
Identity Card No(for Malaysian only)身分证号码(马来西亚唯一)
Mode of Transport运输方式飞机 Sea海 Land土地
Fight No./Vehicle Registration No./Name of ship/Name of Train航班号/车辆登记编号/姓名船舶/姓名的列车
Seat No.机座号
Last Place of Embarkation最后登机地:
Address in Malaysia在马来西亚的住址:
Telephone No.House家里电话: 手机
---------------------
Part B B部分
Influenza a(H1N1)流行性感冒(H1N1病毒)
1 Have you been tu any area or country with local transmission of influenza A(H1N1)as indicated by the world Health Organization over the past?days? 1你有没有涂任何地区或国家与地方的传播流行性感冒( H1N1病毒)所示由世界卫生组织过去?天?
No
2 if Yes,Please specify the said area/countries如果有,请具体说,地区/国家:
3.Date of departure from the said countries离开日期从上述国家:
4.Have you had any of the following symptoms over the past 7 days?。你有下列任何一种症状,在过去7天内的? no
High fever(more than 38度 or more than 100.4度f 发高烧(超过38度或超过100.4度f NO
Cough/Difficulty in breathing or shortness of breath 咳嗽/呼吸困难或呼吸急促 No
Others/(please specify)其他/ (请注明)
5.Have you been in contact with aperson suspected to have Influenza A(H1N1) 5.你有接触过怀疑流行性感冒的人吗?( H1N1病毒) no
6.if the answer is yes to either of the question above,please report to the Health Quarantine Station 如果答案是肯定的任何问题,请向卫生检疫站