1. Quarantine Exemption Application

(front side)

□ fully vaccinated abroad

* Check if you have had the required full doses of vaccine overseas at least two weeks before

Applicant

Name

Sex

[ ] Male

[ ] Female

Nationality

Date of Bbirth

Passport Nno.

Applicant’s Mmobile Pphone Nno.

of Applicant

Status of Sstay (in case of foreign nationals)

Emergency Ccontact Nno. in Korea

(Iinviting company, family, etc.)

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

Affiliation (Ccompany Nname/T, title)

Contact Nno. of Iinviting Ccompany and Official person in Ccharge

Country of Ddeparture for Korea

Date of Ddeparture and Fflight Nno.

Expected Ddate of Aarrival in Korea

Quarantine Eexemption Pperiod

Expected Ddate of Ddeparture from Korea

Place of Visitevent (Ffuneral, etc.)

Reasons of applying for quarantine exemption

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

Documents to be submitted

※(Example)  Please attach a copy of the applicant’s passport, evidence materials (documents to prove the stated purpose of  the visitrelated to business or visiting purposes, death certificate, etc) (e.g. documents related to the business or event, death certificate, vaccination certificate, papers to prove family relationship, etc), planeand airline tickets, etc..

Although I, the applicant, am aware that entrants to the Republic of Korea the person above isare subject to the Special Entry Procedure upon arrival in Korea and quarantine for 140 days after the entry in compliance with the country’s measures to prevent the spread of COVID-19 infections, he/she I, _____________ , hereby submit this application to the Minister of _____________ and/ the Ambassador or Consul-General of the Republic of Korea to _____________ to appliedy for quarantine exemption from quarantine for reasons as stated above.

※ The person aboveI  agrees that his/hermy personal information will be collected and , used, and be provided to the a third party, (including public administrative agencies and medical institutions related to COVID-19 control and prevention, includingsuch as the Ministry of Health and Welfare, the Centers for Disease Control and Prevention AdministrationKorea Disease Control and Prevention Agency, the Ministry of Foreign Affairs and diplomatic offices abroadits overseas missions, the Ministry of Justice, the Ministry of Land, Infrastructure, and Transport, the National Police Agency, healthcare and medical centers, or hospitals, etc.) pursuant to Article 15 and Article 17 of the Personal Information and Protection Act.        .                                                                     (agree □    disagree □)

Date :      yy      mm      dd

Applicant’s name :              (signature)

Guarantor (representative of inviting company or organization) :

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

To Minister of  ______________________

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

Received by

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

Date of Applicationreceipt

yy            mm           dd

Noticee

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

2. TheA person exempt from quarantine must faithfully execute his/her dutiesobligations to receive a diagnostic test, conduct active monitoring, comply with infection preventiveon guidelines, perform activities stated onadhere to thethe Activity Plan duringItinerary for QQuarantine EExemption PPeriod, and follow quarantine/isolation orders.

3. The Quarantine Exemption Applications submitted to the relevant Minister and the Ambassador or Consul-General of the Republic of Korea should be identical.

Activity Plan

during Itinerary for Quarantine Exemption Period

(back side)

○ Activity plansItinerary for each day ※  (filled in by the person exempt from quarantine,applicant or the inviting company/ or 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 140 days, and up to 7 days in case of visits on a humanitarian purposes). This mayshould include information on the places and people to visit and transport to use during the travel such as a personal car or a vehicle provided by the inviting company. Please be reminded that you are not allowed to use public transportation. (If necessary, aYou may attach additional pages to provide detailsled plans in a separate paper, as needed.)

※ not necessary if the applicant has received the full doses of vaccine

I understand and agree that submittingproviding false information to the Minister of _____________ and the Ambassador or Consul-General of the Republic of Korea to _____________to the Minister of _____________ / the Ambassador or Consul-General of the Republic of Korea to _____________  on the Activity Plan duringItinerary for Quarantine Exemption Period will result in criminal punishment in accordance with the Infectious Disease Control and Prevention Act, and/or the refusaldenial 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.)I agree that my personal information will be collected, used, and provided to a third party, including public administrative agencies and medical institutions related to COVID-19 control and prevention, such as the Ministry of Health and Welfare, the Centers for Disease Control and Prevention,the Korea Disease Control and Prevention Agency,  the Ministry of Foreign Affairs and its overseas missions, the Ministry of Justice, the Ministry of Land, Infrastructure, and Transport, the National Police Agency, healthcare and medical centers, or hospitals, pursuant to Article 15 and Article 17 of the Personal Information and  Protection Act.                                                     (agree □    disagree □)

Applicant’s name ____________ (signature)

Date :      yy      mm      dd

Applicant’s name :              (signature)

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

2. Agreement to the Terms and Conditions Quarantine Exemption Agreement

1.  I, the applicant for quarantine exemption, hereby agree to comply with all of the clausesobligations* specified under the Note ion the Quarantine Exemption cCertificate.

* DutiesObligations to receive a diagnostic test upon entering the Republic of Korea and wait for the test results; receiveget a diagnostic test within 56-7 days of entry and submit a copy of a negative COVID-19 test result within 8 days of entry; conduct active monitoring, including installing the Self-CheckCheck aapplication and , Self-Check Mobile App,recordingporting reporting daily health status via the app, and answering phone calls from the health authoritiescall center; comply with infection preventiveon guidelines,; adhere to the Itinerary forpursue activities stated on the Activity Plan during  Quarantine Exemption Period (not applicable for people fully vaccinated overseas and exempt from quarantine); and comply with isolation measuresorders made by the disease control authorities in case ofas necessityary, such asespecially when testing positive for COVID-19.

2. I was notified of the following and agree that any violations of the following can lead to civil and criminal punishment in accordance with related laws and regulations.

(1) If I fail to submit a negative PCR test result issued lawfully in the entry process (within 72 hours prior to the date of departure), Quarantine Exemption Certificate becomes invalid.

If I fail to submit a negative PCR test result issued lawfully in the entry process (within 48 hours prior to the date of departure) in accordance with the standards of submitting a PCR negative test result, Quarantine Exemption Certificate becomes invalid.

(2) If I fail to receive a diagnostic test within 6-7 days after arrival and submit a negative PCR test result to the examination authorities and the local government responsible for my place of address, Quarantine Exemption Certificate becomes invalid.

(3) If I was issued Quarantine Exemption Certificate as a person fully vaccinated abroad, and confirmed to have stayed in, departed from, or had a layover in any countries excluded from quarantine exemption for those who completed vaccinationcurrently or newly designated as those hit by the Beta, Gamma, Delta COVID-19 variantsquarantine exemption for fully vaccinated visitors, within 144 days before entering into Korea, Quarantine Exemption Certificate for people fully vaccinated overseas becomes invalid.

2.  I understand and agree that the validity of thethe quarantine exemption will terminate, and I will be subject to self-quarantine or facility quarantine at my own expense, if I fail tofail to submitprovide a proof of a negative COVID-19 PCR test result issued within 72 hours prior to the departure date upon arrival, or fail fail to receive a diagnostic test within 5-7 days of entry and do not submit athe negative COVID-19 PCR test result within 8 days of entry.

23.  I understandaccept and agree that my activities in the Republic of Korea will be limited only to the original veryintended purpose of my visitfor which my as stated on my application for quarantine exemption application has been filed. I understand and agree that the validity of I will face immediate suspension of the quarantine exemption will immediately terminate and that I will be subject to self-quarantine or facility quarantine*, if I pursue any activityies on a purpose other than the intendedstated purpose during myof my visit or if I am identified as a contact (a suspected case of COVID-19) of a confirmed cases or a suspected case of COVID-19.

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

34. I understand and agree that submittingproviding false information on the Quarantine Exemption Application and failing to comply with any of the dutiesobligations stated above under the first  (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, paragraph will result in criminal punishment in accordance with the Infectious Disease Control and Prevention Act, and/or the refusaldenial 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.) I agree that my personal information will be collected, used, and provided to a third party, including public administrative agencies and medical institutions related to COVID-19 control and prevention, such as the Ministry of Health and Welfare, the Centers for Disease Control and PreventionKorea Disease Control and Prevention Agency, the Ministry of Foreign Affairs and its overseas missions, the Ministry of Justice, the Ministry of Land, Infrastructure, and Transport, the National Police Agency, healthcare and medical centers, or hospitals, pursuant to Article 15 and Article 17 of the Personal Information and Protection Act.                                               (agree □    disagree □)

Date :      yy      mm      dd

Applicant’s name :           (signature)

To Minister of  ______________________

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

3. Pledge of Authenticity

(only for people applying for quarantine exemption as a person fully vaccinated overseas)

I, ______________, applying for quarantine exemption as the person fully vaccinated overseas, hereby pledge to confirm the followings.

- Submitting forged, falsified or false Vaccination Certificate will make Quarantine Exemption Certificate invalid and result in criminal punishment in accordance with Criminal Act (Article 137, Article 231 and Article 234), Infectious Disease Control and Prevention Act (Article 42, Article 47 and Article 49) and Immigration Act (Article 11 and Article 46).

- If the submitted Vaccination Certificate is confirmed to be forged, falsified or false, and if I infect others after being confirmed, I can be held liable for medical indemnity costs for myself and the people that I infected.

※ I agree that my personal information will be collected, used, and provided to a third party, including public administrative agencies and medical institutions related to COVID-19 control and prevention, such as the Ministry of Health and Welfare, the Korea Disease Control and Prevention Agency, the Ministry of Foreign Affairs and its overseas missions, the Ministry of Justice, the Ministry of Land, Infrastructure, and Transport, the National Police Agency, healthcare and medical centers, or hospitals, pursuant to Article 15 and Article 17 of the Personal Information Protection Act.                          (agree □    disagree □)

Date :      yy      mm      dd

Applicant’s name :           (signature)

34. Performance MemorandumPledge of for Compliance of PreventiveSupervision Guidelines

1. The personI, (representative’s name ______________) (hereinafter “the person”) , the representative of the inviting company, hereby pledges to the Minister of ____________________ to

arrange with establish disease control guidelines for ______________, the traveler exempt from quarantinetraveler of (___________ nationality __________, date of birthborn on __________, sex ____) (hereinafter “the traveler”),

to faithfully observe the disease prevention measures of the Republic of Korea includingby minimizing the movement and limiting the scope of travel and activityies of the traveler and , and faithfully follow, execute and manage the guidelines in accordance with Korea’s disease prevention measuresclosely monitoring the traveler.

I, ______________, the representative of the inviting company or organization, hereby pledge to the Minister of ____________________ to establish COVID-19 preventive measures for

______________, the traveler of ___________ nationality born on __________, (hereinafter “the traveler”), including minimizing the movement and activities of the traveler, and faithfully follow, execute and manage the measures in accordance with the disease prevention guidelines of the Republic of Korea.

2. The personI pledge to take full responsibility for supervising  will fulfill his/her responsibility of making sure that the traveler to ensure him/her faithfully thoroughly followcomply with the noticeobligations* statedpecified under the Note o in n 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 Obligations to receive a diagnostic test for COVID-19 upon entering the Republic of Korea and wait for the test result; receiveget a diagnostic test within 56-7 days of entry and submit a copy of athe negative COVID-19 test result within 8 days of entry; conduct active monitoring, including installing the Self-Check Mobile applicationApp, reporting daily health status via the app, and answering phone calls from the health authorities; comply with infection prevention guidelines; adhere to the Itinerary for Quarantine Exemption Period; and comply with isolation orders made by the disease control authorities as necessary, especially when testing positive for COVID-19

3. The personI willpledge to ensure that the traveler’s activities in the Republic of Korea will arebe limited only to the original intended very purpose of his/her visit as stated on for which his/herthe traveler‘s application for quarantine exemption application has been filed. The personI pledges to fully cooperate with the disease control authorities for epidemiological investigation and quarantine orders onfor the traveler in case ofas necessityary.

4. The personI accept and  agrees that submittingproviding false information on the Quarantine Exemption Application, Quarantine Exemption Certificate, and the Itinerary for Activity Plan during Quarantine Exemption Period will result in criminal or civil punishment in accordance with the relevant laws and regulations, 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.)I agree that my personal information will be collected, used, and provided to a third party, including public administrative agencies and medical institutions related to COVID-19 control and prevention, such as the Ministry of Health and Welfare, the Centers for Disease Control and Prevention,Korea Disease Control and Prevention Agency, the Ministry of Foreign Affairs and its overseas missions, the Ministry of Justice, the Ministry of Land, Infrastructure, and Transport, the National Police Agency, healthcare and medical centers, or hospitals, pursuant to Article 15 and Article 17 of the Personal Information and Protection Act.                          (agree □    disagree □)

Date :      yy      mm      dd

Applicant’sGuarantor’s nName :                 (signature)

To Minister of  ______________________

45. Quarantine Exemption Certificate

[Original]

□ fully vaccinated overseas  □ not applicable

(filled out by the Aapplicant)

Person Eexempt from Qquarantine

Name

Sex

[ ] Male

[ ] Female

Nationality

Date of Bbirth

Passport Nno.

Applicant’s Mmobile Pphone Nno. of Applicant

Status of Sstay (in case of foreign nationals)

Emergency Ccontact Nno. in Korea

(Iinviting company, family, etc.)

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

Affiliation (Ccompany name/T, title)

Contact Nno. of inviting company and officialperson in charge

Country of Ddeparture for Korea

Date of Ddeparture and F flight Nno.

Expected Ddate of Aarrival in Korea

Quarantine Eexemption Pperiod

(     mm     dd -      mm     dd)

Expected Ddate of Ddeparture from Korea

Place of visitevent (funeral, etc.)

(filled out by the public agencymission)

Reasons for Qquarantine Eexemption

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

Documents to be attached

※ Please attach the filled in “Itinerary “Activity Plan duringfor Quarantine Exemption Period,”“ to this certificate. which is the back side of Quarantine Exemption Application(해외 예방접종완료자 해당 없음)Not eligibleapplicable for people fully vaccinated overseas vaccinnations)

Although the person above is subject to the Special Entry Procedure upon arrival in the Republic of Korea and quarantine for 140 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 has reviewed the request and hereby grants exemption to the applicant.

※ Noticee

- The Ccertificate is valid for once, and only when the person entereds the country within 7one daysmonth after the issuance of the Ccertificate.

If the person fails to submit a negative PCR test result issued lawfully in the entry process (within 48 hours prior to the date of departure) in accordance with the standards of submitting a PCR negative test result, Quarantine Exemption Certificate becomes invalid.

- The person who entered Korea will receive a diagnostic test for COVID-19 upon entry into Korea at a tTtemporary testing facilitysite ( Livingresidential Ffacility and wait for the result staying there for up to 2 days). andThe person will be be exempt from quarantine/isolation if tested negative.

* People exempt from quarantine as those fully vaccinated abroad must wait for the test result in a place such as his/her place of accommodation, after the specimen collection at a public health center having jurisdiction over his/her place of address.

Even though the person was issued with the certificate, the validity of the certificate will immediately terminate  and the person will be placed under quarantine/isolation

- 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, or a suspected case of COVID-19, he/she will be subject to quarantine/isolation, and the person should follow thequarantine/isolation guidelines with an immediate suspension of quarantine exemption.

Even though the person was issued the certificate for a person fully vaccinated overseas, the certificate immediately becomes invalid if he/she is confirmed to have stayed in, departed from, or had a layover in any countries currently or newly designated as those hit by the Beta, Gamma, Delta COVID-19 variantscountries excluded from quarantine exemption for those who completed vaccinationfully vaccinated visitors, within 140 days before entering into Korea.

- After arrivalthe entry, the person should report his/her health status every day through install the sSelf-cCheck mobile applicationSelf-Check Mobile App installed  following the instructions of the disease control authorities ,and report his/her health status every day through the app. The person and should receiveanswer daily phone calls from government officials in charge on a daily basis to report his/her health status.

If the Quarantine Exemption Period exceeds 7 days,, the person is obligated to receive a diagnostic test (funded by the government)  within 56-7 days of entry at his or her expense and submit athe copy of negative COVID-19 test result within 8 days of entry to the relevant ministry.to the examination authorities and the local government responsible for his/her place of address. If the person fails to comply with these obligations,, the quarantine exemption may be terminated and he or she may be subject to immediately quarantined.

- The person should comply with disease prevention guidelines, pursue activities as stated on adhere to the ItineraryActivity Plan during for Quarantine Exemption Period (not applicable for those exempt from quarantine after being fully inoculated abroad), and faithfully follow quarantine/isolation orders ofmade by the disease control authorities ifas necessary. If the person pursues any activityies on a purpose other than the intended stated purpose of his/her visit, he/shethe validity of the quarantine exemption will immediately terminate and the person will be subject to quarantine will be subject to quarantine with an immediate suspension of quarantine exemption, and could face criminal punishment or deportation in accordance with the Infectious Disease Control and Prevention Act or other relevant regulations..

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

※ Quarantine exemptionVisits based on Ha humanitarian purpose isareis restricted confined to the case of visiting s for funerals (up to 7 days). If the person stays in Korea exceeding the maximum period of 7 days is exceeded, the person should visit a healthcare center near the address statedin Korea stated in the Ccertificate, report the casehimself/herself, and undergo self-quarantine or facility quarantine (required to pay up to KRW 150,000 a day) in accordance with disease control measures.

If the person stays in Korea exceeding the quarantine exemption period (up to 7 days in case of visits on a humanitarian purpose), he/she should visit a healthcare center near the address in Korea stated in the certificate, report himself/herself, and undergo self-quarantine or facility quarantine (required to pay up to KRW 150,000 a day) until the 15th day of arrival 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.)I, the person exempt from quarantine, agree that my personal information will be collected, used, and provided to a third party, including public administrative agencies and medical institutions related to COVID-19 control and prevention, such as the Ministry of Health and Welfare, the Centers for Disease Control and Prevention,Korea Disease Control and Prevention Agency, the Ministry of Foreign Affairs and its overseas missions, the Ministry of Justice, the Ministry of Land, Infrastructure, and Transport, the National Police Agency, healthcare and medical centers, or hospitals, pursuant to Article 15 and Article 17 of the Personal Information and Protection Act.             (agree □    disagree □)

Issued by

(title)              (name)                    (contact informationno./e-mail)

yy          mm          dd

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