Official and mandatory SATUSEHAT Health Pass PLF application

PLF SATUSEHAT Health Pass (SSHP)
Application for your health certificate

Simple Entry
Reason for travel: Tourism / Business
Document sent via SMS and email

Traveller Information

Last name

First name(s)

Gender

Date of birth (day/month/year)

Email address

Mobile phone number

Nationality

Country of residence

APPLICATION SATUSEHAT - No : - NAME : - SURNAME :

Travel

Select your mode of transportation :

By plane

By boat

Arrival Date

Port of arrival

Flight number (arrival in Indonesia)

Seat number (arrival in Indonesia)

Country of departure :

APPLICATION SATUSEHAT - No : - NAME : - SURNAME :

Passport Information

Passport number

Issuing country of the passport :

Date of issue

Expiration date

APPLICATION SATUSEHAT - No : - NAME : - SURNAME :

Additional Traveller Information

Do you have any of the following symptoms: fever, swollen lymph nodes, or skin lesions/rashes ?

Yes

Have you had close contact with someone showing symptoms of mpox or with animals such as rodents or primates in the 21 days prior to your arrival in Indonesia ?

Yes

Please accept the terms to continue

I acknowledge having read the general terms and conditions of use and service, and accept them without reservation, certifying the accuracy of the information provided in this application.

I agree, in accordance with the provisions of Article L.221-28 1° of the Consumer Code, that the service will be provided as soon as possible following the validation of my order and, in any case, before the expiration of the 14-day withdrawal period provided for in Article L.221-18 of the Consumer Code.

Only in the case where I have authorized the service to be provided before the expiration of the 14-day withdrawal period, I expressly waive, in accordance with the provisions of Article L.221-28 1° of the Consumer Code, the right of withdrawal applicable to distance selling of services.

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