| ENTRY-EXIT INSPECTION AND QUARANTINE THE PEOPLE'S REPUBLIC OF CHINA HEALTH AND QUARANTINE DECLARATION FORM ON ENTRY Name:Shirley Booth Sex:  Male  FemaleBirth Date:1959 yy 02 mm Place of Arrival: Shenzhen From( Country/Region) :UK Passport NO. :CA5728019 Vehicle/Ship/Flight No. :Flight UA 3625 Seat NO. :16E Destination : Changsha, Hunan 1. Please list the countries and cities (towns) that you have visited in the past 4 weeks: London, Paris, Tokyo and Hong Kong. 2. The contact address and telephone number in the next 14 days: Changsha Friendship Hotel 3. Please mark " √" before the items of following symptoms or illness if you have any now.  Fever  Cough  Shortness ofbreath Difficulty breathing  Other disease4. Have you had close contact with any probable or suspected Bird Flu case in the past 14 days?  Yes  No5. Please mark " √" before the items of the following articles if you bring any of them.  Animal  Animalproducts  Plant Plant products  Biological products Waste and used clothing  SoilI hereby declare that all the information given above istrue and correct. Date:November 16,2008 Signature:Shirley Booth Note: 1. For the health of all, please give true and correct information ; 2. You will be sued according to related laws if you give the false information; 3. No entry shall be allowed without the declaration; 4. Body temperature:37℃ . 1. Who need to fill in this form? A. Foreigners who want to take the Chinese nationality. B. Foreigners who apply for entry to China. C. Anyone planning to go to other countries from China. D. Anyone planning to take animals to China. 2. The underlined word " sued" in the Note can be replaced by . A. charged B. sentenced C. prevented D. analyzed 3. Which of the following statements is NOT true according to the form? A. It was by plane that Shirley Booth came to China. B. Shirley Booth has been to at least four cities in the past month. C. Shirley Booth brought some biological products with her. D. Shirley Booth was not in good health after being examined. |