Health Declaration Form for travelers entering Bonaire

To protect your health and the health of the general public of Bonaire, you are required by the public health department of Bonaire to complete this form. This form allows the public health officers to use your information to contact you when necessary in case of issues with regard to COVID-19. It is important to fill out this form completely and accurately. Your information is intended to be held in accordance with applicable laws and is used for public health purposes only. Thank you for your assistance to protect your health and the health of the general public of Bonaire.
One form should be completed by each person. Parents should complete this form for minors.

Please note! If you are travelling to Bonaire from a very high risk country, you must take a PCR test on day 5 after arrival. You can arrange the appointment online via the health declaration form. Take your health declaration printed with you. This contains the appointment you made.

The list of very high risk countries can be found on: www.bonairecrisis.com/en/travel-to-bonaire/.

Please complete this form between 24 and 12 hours before your departure to Bonaire.
Please print this form after completion and keep it in your hand luggage. You may be asked to show this during your journey by a public health officer.

Seat row and letter: please note the row number and letter of your actual seat during the flight on your phone or a paper and save this for a minimum of 14 days after your trip.

Arrival date on Bonaire
Bonaire Resident
Departure date leaving Bonaire

Do you have any of the following symptoms at this moment?
Please check the box if the answer is yes


Have you been in contact with a confirmed case of COVID-19 in the past 14 days?


In which countries, or on which island, have you stayed during the past 14 days?
You are obliged to mention here all the countries or islands where you have been during the past 14 days. (Multiple answers are possible by pressing +)


Do you have a medical or travel insurance, that covers COVID-19 related issues? (Note: Bonaire residents are insured via ZVK, and can answer this question with yes)


Did you do a COVID-19 PCR test or antigen test within the required time frame?


If you did a test, what was the result?



Have you been vaccinated?


If so, with which vaccine?


And on what date/dates were you vaccinated?



Take your proof of vaccination with you when traveling.

Please select the timeslot on which you would like to have your test below. You will receive an email confirmation with the details for the test location.

I am a parent/guardian and completed this form on behalf of a minor: