Coronavirus Self Declaration Form

NISM is resuming certification examinations (for NISM and IBBI) from 16th June 2020 at limited number of test centers. NISM is looking into the possibility of opening more test centers in coming days. Candidates appearing for the certification examinations must wear mask for their own and other’s safety, during the examinations and also carry Self Declaration form in the following format to the center. Candidates shall not be allowed to enter the test center if self-declaration form is not submitted.

Coronavirus Self Declaration Form

The Health and safety of our community is of utmost importance and therefore it is mandated for the appearing candidate to submit the declaration of sound health. Please ensure that the information you provide below is accurate and complete.

Yourname:   ____________________________________________

Registration Number:   _________________________________________________________                                                                               

Examination Date: 


 Examination Time: _________________________________________________                                                                                 

Examination Centre:__________________                                                                                                                      

Your age: ___________________                     

I declare that:

– I have not travelled abroad in the past three months to the date of the scheduled examination

– I have not been in contact with anyone being suspected or diagnosed with COVID-19. 

I also declare that I am not experiencing any of the below health concerns: 

  • Fever 
  • Cough 
  • Shortness ofBreath 
  • Persistent Pain in theChest
  • Sorethroat

Kindly note that in case you were infected with COVID-19 earlier and presently have been tested negative or cured, then on your scheduled exam date, you are mandated to produce an original Medical Certificate, in addition to this Self-Declaration Form.The Medical Certificate shall be issued atleast 24 hours prior to the exam date.Further note that you may be disallowed to enter the test centre to give exam in case you fail to clear the thermal scanner check at the test centre despite carrying a Medical Certificate declaring you as‘fit’.

I acknowledge that the information provided by me as above is accurate and to the best of my knowledge. I hereby assure that the declaration given by me is correct and I have no objection to NSE Academy for taking any action to ensure healthy and safe conditions at the test center.