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Confirmation of Guardianship for the Quarantined
Guardian
Name Telephone
Date of Birth (Alien Registration Number) Relationship with Quarantined Person Address (Place of Quarantine)
Quarantined Person
Name Telephone
Date of Birth (Alien Registration Number) Quarantine Period
The quarantined person has entered the Republic of Korea after submitting the Agreement to Facility Quarantine and thus is subject to facility quarantine, in accordance with Article 42 of the Infectious Disease Control and Prevention Act and Article 16 of the Quarantine Act.
I, the guardian, hereby confirm my guardianship for the quarantined person and pledge to provide the place of quarantine to the said person, abide by the guidelines for home quarantine, and fully cooperate with related institutions including local medical centers and city/provincial governments for their monitoring efforts.
Enclosed: A copy of the guardian’s identification card
Date: _________________
___________________________________________
(Name and Signature of Guardian)
210mm×297mm[백상지 80g/㎡(재활용품)]
