Guest Pre-Arrival Self Declaration Form

La Numa Villas Canggu

Jl. Pantai Batu Mejan, Canggu, Kuta Utara
Badung, 80361
Bali, Indonesia
+62 361 907 44 15
+62 813 3895 8454
[email protected]

We are taking every step we can to ensure that we continue to offer the most memorable experience to our guests whilst ensuring compliance with the Government guidelines. It is a joint responsibility between our guests and the hotel team and we, therefore, ask for your help in ensuring La Numa Villas Canggu remains COVID-19 free.

We require the below personal data for the purpose of maintaining the safety of our guests, staff, and locality. The information on this form is strictly confidential and it will be held securely following GDPR guidelines.

Have you had any Covid-19 symptoms now or in the past 14 days? (required)
NoYes

Have you been diagnosed with confirmed COVID-19 in the last 14 days? (required)
NoYes

Do you live in the same household/or have you been in close contact with someone who has symptoms of COVID-19 and/or who has been in isolation within the last 14 days (ie. Less than 2 meters for more than 15 minutes accumulative in one day) (required)
NoYes

We respectfully ask all guests to follow Public Health guidelines during their stay at La Numa Villas Canggu, including wearing a face covering when transiting around the public areas of the property and upon entering/leaving dining rooms. Please see the Government website for public guidance and the most up-to-date information on the health measures in place.

We recommend our guests download the COVID-19 Tracker App.

I confirm that I have responded truthfully to the above questions based on my current condition and will advise La Numa Villas Canggu if my situation changes.

Guest Full Name(required)

Email (required)

Phone Number (required)

Check-in Date (required)

Check-out Date (required)

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