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CERTIFICATE OF TRAVEL TO FROM THE

This certificate must be presented to transport companies, before boarding, by passengers from the United Kingdom who wish to travel to France, as as to the authorities in charge of control. Failure to do so will result in a refusal of boarding or access to the . It must be accompanied by the presentation of : • A declaration on honour attesting to the absence of symptoms of covid-19 infection and of contact with a confirmed case of covid-19; • An undertaking on honour to undergo an antigen or biological examination on arrival; • An undertaking on honour to isolate oneself for seven days, if necessary in one of the places designated by the French authorities, and an undertaking on honour to undergo a biological virological screening test (PCR) at the end of the isolation period; • For persons aged eleven years or older, a biological virological screening test (PCR) or an antigenic test carried out less than 48 hours before boarding that does not conclude to a covid-19 contamination.

Part to be completed by :

I, the undersigned,

Ms/Mr. :

Born on :

Nationality :

Residing in :

I certify that my reason for travelling is one of the following compelling reasons (tick box) :

French nationals, their spouses (married, and cohabiting) and their .

[ ] 2. A or assimilated national, as well as his/her spouse (married, civil partner and cohabiting partner) and children, who has his/her main residence in France or who joins, in transit through France, his/her main residence in a European Union or assimilated country or the country of his/her nationality.

[ ] 3. Third-country nationals holding a valid French or European residence permit or long-stay visa who have their main residence in France or who are in transit through France to their main residence in a European Union or similar country.

[ ] 4. British nationals and their family members who are beneficiaries of the agreement on the withdrawal of the United Kingdom of and Northern from the European Union and the European Atomic Energy Community.

[ ] 5. Third-country nationals holding a long-stay visa issued for or family reunification of , beneficiaries of subsidiary protection and stateless persons.

[ ] 6. Foreign health or research professionals involved in the fight against Covid-19 as well as their spouse (married, civil partner, cohabiting partner on presentation of proof of community of life) and their children.

[ ] 6bis. Foreign health or research professional recruited as an associate trainee.

[ ] 7. Third-country nationals holding a "Passeport Talent" VLS and their spouses (married, civil union or cohabiting partner on presentation of proof of ) and children.

[ ] 8. Students enrolled in French as a foreign language (FLE) courses prior to enrolment in higher education or admitted to the orals of competitive examinations in French higher education institutions or enrolled for the start of the 2021-2022 academic year. Researcher settling in France at the invitation of a research laboratory, for research activities requiring a physical presence, as well as his/her spouse (married, civil union, cohabiting partner on presentation of proof of community of life) and his/her children.

[ ] 9. Workers in the land, sea and air transport sector or providers of transport services, including drivers of any vehicle carrying goods for use in the territory as well as those who are merely transiting, or travelling as a passenger to position themselves at their home base or for training.

[ ] 10. Foreign nationals working for a diplomatic or consular mission or an international organisation with a headquarters or office in France, as well as their spouse and children, or foreign nationals from third countries staying in France for imperative professional reasons under cover of a mission issued by the State to which they belong.

[ ] 11. Traveller in transit for less than 24 hours in an international zone.

[ ] 12. British officials in the performance of their duties, persons working for the border , customs officers.

[ ] 13. Channel (including operations, maintenance, security) or cross-Channel facilities staff.

Done at ...... on...... /...... /2021 (signature)