In application of article 3 of the decree of 23 March 2020 prescribing the general measures necessary to deal with the Covid epidemic19 in the context of the state of health emergency
I, Ms. / M. :
certify that my trip is related to the following reason (tick the box) authorized by article 3 of the decree of March 23, 2020 prescribing the general measures necessary to deal with the Covid epidemic19 in the context of the state of emergency sanitary :
Travel between the home and the place of exercise of the professional activity, when they are essential for the exercise of activities which cannot be organized in the form of telework or professional displacements which cannot be deferred.
Travel to purchase supplies necessary for professional activity and purchases of basic necessities3 in establishments whose activities remain authorized (list on government.fr).
Consultations and care that cannot be
provided remotely and that cannot be deferred; consultations and care of patients with a long-term condition.
Travel for compelling family reasons, for assistance to vulnerable people or childcare.
Brief trips, within the limit of one hour daily and within a maximum radius of one kilometer around the home, linked either to the individual physical activity of the people, to the exclusion of any collective sporting practice and any proximity to d 'other people, either walking with the only people in the same home, or the needs of pets.
Judicial or administrative summons.
Participation in missions of general interest at the request of the administrative authority.
Made in : (Location)
(Date and time of start of outing must be mentioned)
1 Persons wishing to benefit from one of these exceptions must have, when necessary, when traveling outside their home, a document enabling them to prove that the trip in question falls within the scope of the one of these exceptions.
2 To be used by self-employed workers, when they cannot have proof of travel established by their employer.
3 Including free acquisitions (distribution of foodstuffs ...) and travel related to the receipt of social benefits and the withdrawal of cash.
Some public information centres have hard copies of these Movement Forms available - not everyone has a printer and some are low on ink: