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2. Adakah awda mempunyai penyakit-penyakit kronik seperti berikut:
2. Do you have chronic illnesses as follows:



4. Keterangan Kontek. Sila senaraikan.
4.Contact Details. Please list down.




5. Pengesahan Pengisytiharan
5. Confirmation of Declaration:




Sila cetak ke format pdf dan hantar kepada alamat email COVID19@kkbs.gov.bn
Please print to pdf format and send through email to COVID19@kkbs.gov.bn