JEK
Senior Insider
CERTIFICATE ON HONOR PREFECTURE OF SAINT-BARTHÉLEMY AND SAINT-MARTIN
Pursuant to articles 3 and 5 of decree no 2020-548 of May 11, 2020 prescribing the general measures necessary to deal with a repeat of Covid-19 in the context of medical emergency report
You wish to enter Saint-Barthélemy You must complete this certificate and hand it over to the service responsible for border control on your arrival in Saint-Barthélemy I, the undersigned
Name :. First name: Last Name :
Date of birth:
Place of birth:.
Profession:
Passport / CNI number:
Provenance:
I declare on my honor to travel to Saint-Barthélemy for the following reason (check the box):
{ } compelling personal or family reason (any civil status document demonstrating the family ties, death certificate, etc.)
{ }upon return to the principal domicile (Proof of domicile -3 months)
{ }on the grounds of health relating to the emergency (medical certificate or supporting document for medical appointment)
{ } professional reason which cannot be deferred (Proof of domicile -3 months, employer certificate stating the urgency, convocation, imperative appointment)
Specify the documents provided to justify the compelling reason: ........................................
Specify if you have stayed during the past 14 days in another territory than Guadeloupe, Martinique, Saint-Martin or Saint-Barthélemy Yes No
If yes, which one (s):..................
I am informed that I will be subject for this purpose to a check by the transport company and / or the forces of the order and that at any time my access could be refused in the absence of proof or production of a forgery, without prejudice to further criminal proceedings. I am informed that individual measures of prohibition can be pronounced according to the importance of the risk of contamination and the local circumstances. I also agree to respect the distancing measures as well as the so-called “barrier” measures such as wearing a mask during my trip.
I finally declare on my honor that (tick the box of your choice):
{ } I am informed of the obligation of strict confinement at home. for a period of 14 days from this day, this fortnight applying to all passengers who accompany me, by air or sea.
{ } Or I agree to a screening and testing protocol carried out by the Bio Pôle laboratory in Saint-Barthélemy, in order to limit the risk of contamination. This protocol consists of a PCR test and a serology test within 24 hours of my arrival and a second PCR test on D + 6. Until the completion of the first test,
I agree to remain strictly confined to my home and not to have contact with third parties. In the event of a negative test on D + 24h, I agree not to return to work (except teleworking), not to frequent places open to the public which are very crowded such as restaurants, bars, supermarkets, not to educate my children. children. In the event of a second negative test on D + 6, I undertake to continue to strictly observe the barrier gestures. At the slightest symptom suggestive of Covid19, I consult my doctor. To adhere to this screening and testing protocol. I fill in and keep the Authorization for carrying out the tests below and I immediately contact the Bio Pòle laboratory to fix the time for the first test.
OR if the object or the duration of my stay in Saint-Barthélemy is incompatible with compliance with the strict fortnight or the screening test (medical appointment, convocation, imperative professional appointment, etc.), I undertakes to wear a mask in all places open to the public or in the presence of any third party. Specify the length of stay, the overriding purpose of the trip, the date and time of departure from Saint-Barthélemy:
For information: Information and guidance platform of the regional health agency from 8 a.m. to 6 p.m. / 7 days a week : 05 90 99 14 74 Full address in Saint-Barthélemy: E-mail address: Landline number: Mobile phone number: Done on
