I being diagnosed as a confirmed/ suspect case of COVID-19, do hereby voluntarily undertake to maintain strict self-isolation at all times for the prescribed period.

During this period I shall monitor my health and those around me and interact with the assigned surveillance team/with the call center, in case I suffer from any deteriorating symptoms or any of my close family contacts develops any symptoms consistent with COVID-19.

I have been explained in detail about the precautions that I need to follow while I am under self-isolation.

I am liable to be acted on under the prescribed law for any non-adherence to self-isolation protocol.