SNSU Subay App

Type of Declaration

Country

First Name

Middle Name

Last Name

Name Ext.

Valid ID

ID Number

Contact Number

Email Address (Optional)

Gender

Birth Date

Current Address

City / Municipality

Barangay

Street Address

Origin [within PH]

Region

Province

City

Barangay

Have you been sick in any of the following in the last 14 days?

a. Fever (Lagnat)

b. Cough (Ubo)

c. Colds (Sipon)

d. Sore Throat

e. Diarrhea

f. Difficulty in Breathing

Other Known Pre-illness or Comorbidities

For e-HEALTH Pass Scanner App (optional)

Optionally, create your one-time user-defined username and password for use in the SDN e-HEALTH Pass Scanner App available for download from Google Play. Please take note of your qr number, username and password.

Username

Password

By clicking "Generate," I agree to the Data Privacy Statement and hereby authorize the Provincial Government of Surigao del Norte including its component City and Municipalities to collect and process the data indicated herein for the purpose of contact tracing effecting control of the COVID-19 transmission. I understand that my personal information is protected by RA 10173, the Data Privacy Act of 2012.

e-HEALTH Pass

Person Registration

Type of Declaration

Basic Information

Current Address

Origin [within PH]

Health Declaration

For e-HEALTH Pass Scanner App (optional)