Health Declaration

Full Name (required)

Complete Address (required)

Contact Number (required)

Email Address (required)

Date of Visit (required)

Time of Visit (required)

Store Visited – Please indicate Brand and Specific branch (required)
—Pizza HutTaco BellDairy Queen

YES I hereby authorize PPI Holdings, Inc., to collect and process the data indicated herein for the purpose of contact tracing effecting control of the COVID-19 transmission.
I understand that my personal information is protected by RA 10173 or the Data Privacy Act of 2012 and that this form will be destroyed after 30 days from the date of accomplishment, following the National Archives of the Philippines protocol.
Please leave this field empty.