• Have visited any location that has been identified with an outbreak of Covid-19 (Wuhan Coronavirus) in the past 14 days?
  
  Yes
  No
• Have been in a meeting, gathering, office or group location where Covid-19 (Wuhan Coronavirus) has been diagnosed afterward, within the last 14 days?
  
  Yes
  No
• Had any contact with Covid-19 (Wuhan Coronavirus) related patients in the past 14 days?
  
  Yes
  No

Please advise name of the countries you have visited in the past 14 days prior arriving to Bali/Jakarta (if any):

Country Name

  I hereby declare that all information I have stated above is true and understand that the hotel reserves the rights to refuse entry.