文档介绍：第 2 页
FULL NAME(全名，全部要大写-BLOCK LETTERS，每行写一个汉字拼音)
SWX(男就选Male, 女就选Female)
Place of Issue(护照签发地，例：辽宁，就写Liaoning)户照ROVIDE THE FOLLOWING INFORMATION(ONLY ONE DECLARATION PER FAMILY IS REQUIRED)每个旅行者负责任家庭成员必须提供以下资料〔只能选择其中一项宣言每个家庭为必填项〕
FULL NAME (AS APPEARS IN PASSPORT)姓名:
PASSPORT NO护照号:
NUMBER OF FAMILY MEMBERS TRAVELING TOGETHER同行家庭人员数量：
PLEASE TICK() IN THE RELEVANT BOX AFTER READING THE NOTICE ON PAGE 6在方框内打勾并读第6页公告：
GOODS TO DECLARE(申报〕PLEASE DECLARE ON PAGE 6 AND PROCCEED TO CUSTOMS EXAMINATION LANE请申报第6页及PROCCEED海关检验巷
第 5 页
NOTHING TO DECLARE(不申报〕PLEASE PRCCEED TO GREEN LANE请通过绿色巷
I HAVE READ THE NOTICE AND CERTIFY THAT THIS DECLARATION IS TRUE我已经阅读了公告，并证明，我说是真。
SIGNATURE签名 DATE日期
***反面***
PLEASE DECLARE ALL GOODS IN EXCESS OF THE DUTY EXEMPTIONS请申报所有货品超过免税待遇:
货品描述/数量/多少钱
PLANT QUARANTINE DECLARATION植物检疫宣言(全填NO)
Have you been to Africa Central or South America during the last 30 days你去过非洲或南美洲中部在过去30天？
and jor
Are you carrying any plant materi看不清楚。填NO
HEALTH QUARANTINE DECLARATION 卫生检疫宣言
都填NO
CURRENCY DECLARATION 货币宣言
〔可不填〕
HEALTH DECLARATION FORM (安康申报表)
All persons entering Malaysia shall furnish information as required in this form 所有进入马来西亚人应提供资料要求此表
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PART A (General)
Full name 全名
Gender 性别
Age出生日期
Passport Number护照号
Nationality国籍
Identity Card No(for Malaysian only)身分证号码〔马来西亚唯一〕
Mode of Transport运输方式:Air飞机 Sea海 Land土地
Fight No./Vehicle Registration No./Name of ship/Name of Train航班号/车辆登记编号/姓名船舶/姓名列车
Last Place of Embarkation最后登机地:
Address in Malaysia在马来西亚住址:
Telephone ： 手机
Part B B局部
Influenza a(H1N1)流行性感冒〔H1N1病毒)
1 Have you been tu any area or country with local transmission of influenza A(H1N1)as indicated by the world Health Organization over the pastdays 1你有没有涂任何地区或国家与地方传播流行性感冒〔 H1N1病毒〕所示由世界卫生组织过去？天？No
2 if Yes,Please specify the said area/countries如果有，请具体说，地区/国家：
of departure from the said countries离开日期从上述国家：
第 7 页
you had any of the following symptoms over the past 7 day