1. Quarantine Exemption Application

(front side)

Applicant

Name

Sex

[ ] Male

[ ] Female

Nationality

Date of Birth

Passport No.

Mobile Phone No.

of Applicant

Status of Stay (in case of foreign nationals)

Emergency Contact No. in Korea (Inviting company, family, etc)

Address in Korea (Please provide a full address)                        (Tel.:                   )

Affiliation (Company Name/Title)

Contact No. of Inviting Company and Official in Charge

Country of Departure

Date of Departure and Flight No.

Expected Date of Arrival

Quarantine Exemption Period

Expected Date of Departure

Place of Visit (Funeral, etc.)

Reasons of applying for quarantine exemption

※ Please provide reasons in detail with the purpose of visit, such as important business (contract, investment, etc), academic/public/humanitarian purposes, etc.

Documents to be submitted

※(Example) Please attach a copy of passport, evidence materials (documents related to business or visiting purposes, death certificate, etc), plane ticket, etc.

Although the person above is subject to the Special Entry Procedure upon arrival in Korea and quarantine for 14 days after the entry to prevent COVID-19 infections, he/she applied for exemption from quarantine for reasons as stated above.

※ The person above agrees that his/her personal information will be collected and used, and be provided to the third party (public administrative agencies and medical institutions related to COVID-19 control and prevention, including Ministry of Health and Welfare, Disease Control and Prevention Administration, Ministry of Foreign Affairs and diplomatic offices abroad, Ministry of Justice, Ministry of Land, Infrastructure, and Transport, National Police Agency, health and medical centers, hospitals, etc.) (agree □    disagree □)

Date :      yy      mm      dd

Applicant’s name :              (signature)

Guarantor (representative of inviting company or organization) :

(Company Name) _____________ / (Guarantor’s Name) _____________   (signature)

To Minister of  ______________________

To Ambassador(Consul General) of the Republic of Korea to ___________

Received by

Ministry of _______ / Embassy of _______ or Department Name) (title)       (name)

Date of Application

yy            mm           dd

Notice

1. I understand and agree that submitting false information on the Quarantine Exemption Application will result in criminal punishment in accordance with the Infectious Disease Control and Prevention Act.

2. The person exempt from quarantine must faithfully execute his/her duties to receive diagnostic test, conduct active monitoring, comply with preventive guidelines, perform activities stated on the Activity Plan during Quarantine Exemption Period, and follow quarantine/isolation order.

Activity Plan

during Quarantine Exemption Period (back side)

○ Activity plans for each day ※ filled by the person exempt from quarantine, or inviting company/organization

※ Please provide detailed plans, including information on the places and people (business partners, etc) to visit, and transport to use during the travel, such as a personal car or the inviting company’s car (not allowed to use public transportation), for the entire period of quarantine exemption (up to 14 days, and 7 days in case of humanitarian purposes). (If necessary, attach additional details in a separate paper.)

I understand and agree that submitting false information on the Activity Plan during Quarantine Exemption Period will result in criminal punishment in accordance with the Infectious Disease Control and Prevention Act, or the refusal of entry, deportation, or criminal punishment in accordance with the Immigration Act.

※ The person above agrees that his/her personal information will be collected and used, and be provided to the third party (public administrative agencies and medical institutions related to COVID-19 control and prevention, including Ministry of Health and Welfare, Disease Control and Prevention Administration, Ministry of Foreign Affairs and diplomatic offices abroad, Ministry of Justice, Ministry of Land, Infrastructure, and Transport, National Police Agency, health and medical centers, hospitals, etc.) (agree □    disagree □)

Applicant’s name ____________ (signature)

Date :      yy      mm      dd

Applicant’s name :              (signature)

Guarantor’s name (representative of inviting company or organization) :          (signature)

To Minister of  ______________________

To Ambassador(Consul General) of the Republic of Korea to ___________

2. Quarantine Exemption Agreement

1. I agree to comply with all of the clauses* specified in the certificate.

* Duties to receive diagnostic test upon entering the Republic of Korea and wait for test results; conduct active monitoring, including installing the Self-Check application and recording daily health status, answering phone calls from the call center; comply with preventive guidelines, pursue activities stated on the Activity Plan during Quarantine Exemption Period; and comply with isolation measures by the disease control authorities in case of necessity, such as testing positive for COVID-19

2. I understand and agree that my activities in the Republic of Korea will be limited only to the original intended purpose for which my quarantine exemption application has been filed. I understand and agree that I will face immediate suspension of quarantine exemption and will be subject to self-quarantine or facility quarantine* if I pursue any activity other than the intended purpose during my visit or if I am identified as a contact (a suspected case of COVID-19) of a confirmed cases.

* required to pay for the use of the facility (up to KRW 150,000 per day) if placed under facility quarantine

3. I understand and agree that submitting false information on the Quarantine Exemption Application and failing to comply with the duties stated above (1.), including refusing to receive diagnostic test, perform active monitoring duties, pursue activities stated on the Activity Plan during Quarantine Exemption Period, or failing to follow quarantine/isolation orders, will result in criminal punishment in accordance with the Infectious Disease Control and Prevention Act, or the refusal of entry, deportation, or criminal punishment in accordance with the Immigration Act.

※ The person above agrees that his/her personal information will be collected and used, and be provided to the third party (public administrative agencies and medical institutions related to COVID-19 control and prevention, including Ministry of Health and Welfare, Disease Control and Prevention Administration, Ministry of Foreign Affairs and diplomatic offices abroad, Ministry of Justice, Ministry of Land, Infrastructure, and Transport, National Police Agency, health and medical centers, hospitals, etc.) (agree □    disagree □)

Date :      yy      mm      dd

Applicant’s name :           (signature)

To Minister of  ______________________

To Ambassador(Consul General) of the Republic of Korea to ___________

3. Performance Memorandum for Compliance of Preventive Guidelines

1. The person (representative’s name __________) (hereinafter “the person”) pledges to establish disease control guidelines for the traveler exempt from quarantine ( nationality __________, date of birth __________, sex ____) (hereinafter “the traveler”), including limiting the scope of travel and activity, and faithfully follow, execute and manage the guidelines in accordance with Korea’s disease prevention measures.

2. The person will fulfill his/her responsibility of making sure that the traveler thoroughly follow the notice* stated in the Quarantine Exemption Certificate.

* Duties to receive diagnostic test upon arrival in Korea (and wait for test results), perform active monitoring (install the self-check mobile application and record daily health status, receive phone calls from the call center, etc), comply with preventive guidelines, pursue activities as stated in the Activity Plan during Quarantine Exemption Period, and faithfully follow quarantine/isolation orders of the disease control authorities in case of necessity, such as testing positive for COVID-19

3. The person will ensure that the traveler’s activities in the Republic of Korea will be limited only to the original intended purpose for which his/her quarantine exemption application has been filed. The person pledges to fully cooperate with the disease control authorities for epidemiological investigation and quarantine order on the traveler in case of necessity.

4. The person agrees that submitting false information on the Quarantine Exemption Application, Quarantine Exemption Certificate, and the Activity Plan during Quarantine Exemption Period will result in criminal or civil punishment in accordance with the relevant laws, such as the Infectious Disease Control and Prevention Act.

※ The person above agrees that his/her personal information will be collected and used, and be provided to the third party (public administrative agencies and medical institutions related to COVID-19 control and prevention, including Ministry of Health and Welfare, Disease Control and Prevention Administration, Ministry of Foreign Affairs and diplomatic offices abroad, Ministry of Justice, Ministry of Land, Infrastructure, and Transport, National Police Agency, health and medical centers, hospitals, etc.) (agree □    disagree □)

Date :      yy      mm      dd

Applicant’s name :          (signature)

To Minister of  ______________________

4. Quarantine Exemption Certificate

[Original]

(filled by the Applicant)

Person Exempt from Quarantine

Name

Sex

[ ] Male

[ ] Female

Nationality

Date of Birth

Passport No.

Mobile Phone No. of Applicant

Status of Stay (in case of foreign nationals)

Emergency Contact No. in Korea

(Inviting company, family, etc.)

Address in Korea (Please provide a full address)                    (Tel.:                        )

Affiliation (Company name/Title)

Contact No. of inviting company and official in charge

Country of Departure

Date of Departure and Flight No.

Expected Date of Arrival

Quarantine Exemption Period

(     mm     dd -      mm     dd)

Expected Date of Departure

Place of visit (funeral, etc.)

(filled by the public agency)

Reasons for Quarantine Exemption

※ Please provide reasons in detail with the purpose of visit, such as important business (contract, investment, etc), academic/public/humanitarian purposes, etc.

Documents to be attached

※ Please attach the “Activity Plan during Quarantine Exemption Period,” which is the back side of Quarantine Exemption Application

Although the person above is subject to the Special Entry Procedure upon arrival in Korea and quarantine for 14 days after the entry to prevent the spread of COVID-19, the person applied for exemption from quarantine for reasons as stated above. The officer in charge reviewed the request and hereby grants exemption to the applicant.

※ Notice

- The Certificate is valid for once, only when the person entered the country within 7 days after the issuance of the Certificate.

- The person who entered Korea will receive diagnostic test at temporary testing facility (staying up to 2 days) and be exempt from quarantine/isolation if tested negative.

- In spite of the Certificate, if the person tests positive upon arrival or is identified as a contact (a suspected case of COVID-19) of a confirmed case, he/she will be subject to quarantine/isolation and should follow the guidelines with an immediate suspension of quarantine exemption.

- After arrival, the person should report his/her health status every day through the self-check mobile application installed following the instructions of the disease control authorities, and receive phone calls from government officials in charge on a daily basis to report his/her health status.

- The person should comply with disease prevention guidelines, pursue activities as stated on the Activity Plan during Quarantine Exemption Period, and faithfully follow quarantine/isolation orders of the disease control authorities if necessary. If the person pursues any activity other than the intended purpose, he/she will be subject to quarantine with an immediate suspension of quarantine exemption, and face criminal punishment or deportation in accordance with the Infectious Disease Control and Prevention Act.

- Submitting false information will result in criminal punishment in accordance with the Infectious Disease Control and Prevention Act, or the refusal of entry, deportation or criminal punishment in accordance with the Immigration Act.

※ Humanitarian purpose is confined to the case of visiting funerals (up to 7 days). If the maximum period of 7 days is exceeded, the person should visit a health center near the address stated in the Certificate, report the case and undergo self-quarantine or facility quarantine (required to pay up to KRW 150,000) in accordance with disease control measures.

※ The person above agrees that his/her personal information will be collected and used, and be provided to the third party (public administrative agencies and medical institutions related to COVID-19 control and prevention, including Ministry of Health and Welfare, Disease Control and Prevention Administration, Ministry of Foreign Affairs and diplomatic offices abroad, Ministry of Justice, Ministry of Land, Infrastructure, and Transport, National Police Agency, health and medical centers, hospitals, etc.) (agree □    disagree □)

Issued by

(title)              (name)                    (contact information/e-mail)

yy          mm          dd

Embassy (Consul General) of the Republic of Korea to ___________