COVID-19 Controlled Repatriation Response Application Form for Displaced Abroad

HOW DOES THE APPLICATION FOR CONTROLLED REPATRIATION FOR DISPLACED BELIZEANS ABROAD WORK?

If you are a Belizean whose permanent country of residence is Belize and you have been unable to travel home due to the closure of our borders as a result of the COVID-19 pandemic, you will now be able plan your return. Note that this can only be done with prior coordination and approval from . The reason for coordination and approval is required is to limit, as much as possible, the spread of COVID-19 and protect the health and safety of all those in Belize, especially those most vulnerable. From Monday, 18 May 2020, displaced Belizeans can visit our online portal available on the https:// www.covid19.bz/ or via the link COVID19 link on the https://mfa.gov.bz/ website. For now, applicants will have to email their responses to the questions to: [email protected] Applicants must also attach the passport and health-related (if applicable) information requested.

In the interest of public health and safety, approvals for re-entry will be phased in a manner deemed appropriate by the Ministry of Health, the designated Quarantine Authority and other key ministries. WARNING: DO NOT ATTEMPT TO TRAVEL TO BELIZE WITHOUT PRIOR APPROVAL

THE PROCESS, STEP BY STEP Step 1 YOU COMPLETE THE APPLICATION FORMS: 1. Application Form for Belizeans Displaced Abroad. Email responses to [email protected] 2. COVID-19 Screening Application Form - available at: https://www.covid19.bz/ https:// mfa.gov.bz/ 3. Both forms must be completed if you wish to be considered for re-entry to Belize. 4. You will receive an email confirming receipt of your application. Step 2 YOU RECEIVE APPROVAL TO RETURN TO BELIZE. Step 3 YOU WILL THEN BE ABLE TO BOOK YOUR TRAVEL Step 4 SEND CONFIRMATION OF INTENDED ARRIVAL (PGIA/LAND/SEA) TO: [email protected] Step 5 EXPECT THAT UPON YOUR RETURN TO BELIZE YOU WILL BE SCREENED AND MAY BE SWABBED FOR COVID-19. THIS IS A CONDITION OF RETURN. THIS WILL BE DONE AT THE POINT OF ENTRY. ALL PERSONS ENTERING BELIZE SHOULD EXERCISE PATIENCE AS SOCIAL DISTANCE AND HEALTH AND SAFETY PROTOCOLS WILL BE OBSERVED.

COVID-19 Belize Controlled Repatriation Response Application Form for Belizeans Displaced Abroad

Step 6 YOU WILL THEN BE TRANSPORTED TO THE PRE-APPROVED AND AGREED QUARANTINE LOCATION. NEITHER FRIENDS, FAMILY MEMBERS OR PRIVATELY HIRED VEHICLES WILL BE ALLOWED TO TRANSFER YOU FROM THE POINT OF ENTRY TO QUARANTINE HOTEL. 3 MEALS AND ACCOMMODATION ARE INCLUDED IN THE COST OF QUARANTINE WHICH MUST BE MET BY NATIONALS WHO HAVE DECIDED TO RETURN (EXCEPT IN EXCEPTIONAL CASES, FOR EXAMPLE CHRONIC OR TERMINAL ILLNESS). STRICT QUARANTINE MUST BE OBSERVED - THIS MEANS YOU MUST STAY IN YOUR ALLOCATED SPACE AND LIMIT CONTACT FOR 14 DAYS. YOU MUST WASH HANDS OR USE SANITIZER BEFORE AND AFTER CONTACT WITH ANY OTHER PERSON AND MUST WEAR A MASK IF IN CONTACT WITH ANY OTHER PERSON OR IF YOU MUST TRANSIT A PUBLIC AREA FOR ANY EXCEPTIONAL REASON DURING THIS 14 DAY PERIOD. NO FAMILY OR OTHER VISITS WILL BE ALLOWED. THE PENALTY FOR RISKING THE LIVES OF OTHERS AND BREAKING QUARANTINE IS SERIOUS. Step 7 AFTER 14 DAYS, AND IF YOU SHOW NO SYMPTOMS YOU WILL BE PERMITTED TO RETURN TO YOUR RESIDENCE. ALL BELIZEANS MUST STILL WEAR MASKS IN PUBLIC, MUST OBSERVE HYGEINE PROTOCOLS, AND MUST CONTINUE TO OBSERVE SOCIAL DISTANCING OF 6FT.

BY PROCEEDING TO COMPLETE APPLICATION BELOW, I CONFIRM THAT I HAVE READ, UNDERSTAND, AND AGREE TO COMPLY WITH THE INSTRUCTIONS ON THIS FORM IN ORDER TO RETURN TO BELIZE.

I CONFIRM THAT I HAVE READ, UNDERSTAND AND AGREE TO COMPLY WITH THE INSTRUCTIONS ON THIS FORM IN ORDER TO RETURN TO BELIZE

COVID-19 Belize Controlled Repatriation Response Application Form for Belizeans Displaced Abroad

Any Belizean resident wishing to return to Belize at this time must complete the application form/Questions below and the COVID-19 Self-Test. Please email your responses to the questions below to [email protected] You must also attest to normally residing in Belize. Note that a false declaration on this Government of Belize Form is an offence under the Laws of Belize.

Timestamp: 2020-05-19

Last Name (as on passport):

First Name (as on passport):

Middle Name (as on passport):

Contact Email:

Contact Telephone:

Current Address:

Sex: Male Female

Nationality:

Passport Number: Please attach, along with a copy of this document, a picture of your Passport's ID page.

Place of Issue:

Date of Birth:

Place of Birth:

Date of Issue: If No, please urgently contact your nearest Belizean Embassy or Consulate Is your Passport Valid?: Expiry Date: YES NO (www.mfa.gov.bz)

Will you be traveling with family Members? Adults: Children

COVID-19 Belize Controlled Repatriation Response Application Form for Belizeans Displaced Abroad

Next of Kin in Belize (Full Name):

Next of Kin contact address in Belize:

Next of Kin contact Telephone

When did you leave Belize?

Please attach, along with a copy of this document, a picture of the passport page with your last departure stamp.

Purpose of stay outside of Belize: Study Business Tourism

Health Official Other

Current Address (Abroad)

Where have you travelled since leaving Belize?

Where have you travelled within the past 21 days?

Have you Been tested for COVID-19? YES NO

Where? (If Yes)

Have you been diagnosed as having COVID-19? YES NO

Have you had an anti-body test for COVID-19? (If Yes, Please state where. Else, leave blank.)

Priority will be given to patients with chronic medical concerns. Please list Below. (You may be required to submit proof of diagnosis.)

Chronic Medical Concerns

COVID-19 Belize Controlled Repatriation Response Application Form for Belizeans Displaced Abroad

Means of transportation en route to Belize? Air Land Sea

What is your intended route of return to Belize? : Cancun, Miami, USA

Chetumal, Mexico Houston, USA Fort Lauderdale, USA

Guatemala Atlanta, USA Other:

Private Flight

If Other, specify:

What is your address in Belize?

Note: All persons entering Belize must agree to be tested for COVID-19 and must comply with the Quarantine Rules under the State of Emergency SI 72 of 2020. Each person is responsible for paying for their stay in quarantine which will be designated by the Ministry of Health. This is NOT a free service. The Government of Belize cannot prioritize the payment for each national wishing to return when so many Belizeans have lost their livelihoods due to COVID-19.

You will be responsible to pay for your period in quarantine and are therefore given options to accommodate for differences in budgets.

By checking this box, you understand and agree to comply with the conditions of quarantine or face a fine of $5000.00 or 2 years imprisonment (See Statutory Instrument 65 of 2020, Section 22[1]). Failure to observe quarantine puts you and those around you at risk.

Are you currently experiencing any flu-like symptoms or other symptoms linked to COVID-19? Please complete the COVID-19 Self Test (http://reporting.covid19.bz:8080/apex/f?p=141:2) YES NO

I hereby confirm that I have completed the COVID-19 Self test. I acknowledge failure to do so while claiming I have is punishable by the Laws of Belize.

COVID-19 Belize Controlled Repatriation Response Application Form for Belizeans Displaced Abroad

Please provide any other information you feel the Government of Belize should consider.

I hereby acknowledge and accept that I will be placed under quarantine upon arrival to Belize, and agree to pay for the quarantine period. I certify that the information provided above is true and accurate at the time of submission.

Kindly note that your application form will not be considered complete until you indicate your acceptance by checking this box and hitting the submit button below.

Please Print Full Name