All fields must be completed in English
I hereby confirm that the information has provided herein, including my local contact and residential details, is true, accurate, and complete to the best of my knowledge and belief. Learn More
I understand that the truth and accuracy of the information submitted in this form is my responsibility. Should there be any change to the information provided, I undertake to inform the General Department of Immigration (`Authority`), by submitting a fresh declaration. I also undertake to update the information required under this form if requested to do so by the Authority.
I understand that if I provide any false, inaccurate, or incomplete information in this form, I may be held liable to offenses related to such action.
Consent to data sharing with other government agencies:
I consent, for the information I have provided herein,
a. For the Government of Cambodia and statutory authorities to obtain from and verify information (including my medical records and information relating to them) with any person, organization, or any other source.
b. To the release of all information obtained (including my medical records and information relating to them) to the Government of Cambodia, statutory authorities, and their agents.
If you are submitting the arrival card on behalf of someone else (the `Principal`):
I undertake that my Principal is aware of the contents of my submission and that it will be taken to have been personally submitted by him/her. My Principal is aware that he/she may be liable for offense(s) concerning any false, inaccurate, or incomplete statement or declaration contained in the arrival card. I also understand that I may be liable for abetting these offenses.
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