COVID – 19 Declaration Form

Private Jet Services Group (PJS) is following guidance from government and international health agencies and closely monitoring the current outbreak of pneumonia caused by the Novel Coronavirus (COVID-19). This declaration form satisfies the latest TSA Security Directive requirements.

In an effort to provide charter customers, aircraft owners and crew members with a safe environment, we have implemented protocols on our aircraft to support the global efforts to contain the COVID-19 outbreak.

As part of this protocol we require passengers on our aircraft to fill in the following statement as a Pre-requisite to boarding a PJS Aircraft.

Passengers filling out this form, can take solace in PJS’s procedures that ensures passengers prior to their embarkation on a PJS aircraft have gone through the same screening process along with our Post and Pre-Flight Sanitizing procedures.

The undersigned (Passenger name):

______

Hereby declares that he/she has not travelled to/through/from China, Iran or a local outbreak area in Italy or South Korea (see list below) in the 14 days preceding their departure.

Date: ______

Signature: ______

Print Name: ______

Outbreak Areas China All Regions Iran All Regions Italy – Lombardy Region Codogno, Castiglione d’Adda, Casalpusterlengo, Fombio, Maleo, Somaglia, Bertonico, Terranova dei Passerini, Castelgerundo and San Fiorano Italy – Veneto Region Vo’ Euganeo South Korea Daegu Cheongdo

Last Updated 03/10/2020 Private Jet Services Group, LLC 5 Batchelder Road Seabrook, NH 03874 USA +1 (603) 760-0500 www.pjsgroup.com Private Jet Services (PJS) acts as an agent for its clients in negotiating and facilitating transportation with duly licensed Direct Air Carriers. PJS is an agent for Elevate Jet, LLC (FAA# 3LJA9830) and Air Chathams Limited (CAA# AOC26883). PJS is not a Direct Air Carrier and does not operate aircraft. Private Jet Services is a wholly owned subsidiary of Elevate Holding Inc.