GESY entry and exit dates declaration: how to fill it in

Who fills it in

A GHS applicant whose ordinary residence the Health Insurance Organisation checks, for example when an enrolment request is not approved automatically. Each applicant fills in a separate form.

What goes with it

Copies of ALL pages of your passport or passports, including blank pages
If you had more than one passport in the two years (old and new), the stamps from all of them

Field by field

Part 1 — Personal details (PART 1: PERSONAL DETAILS)

On the form	What to write	Example
Name NAME	Your first name as in your passport.	MARIA
Surname SURNAME	As in your passport.	EXAMPLE
Date of birth DATE OF BIRTH	Use the format dd/mm/yyyy, as the instructions say.	01/01/1985
ARC number ARC NUMBER	The number of your Alien Registration Certificate (residence permit or EU registration certificate).	0000000
Passport number(s) PASSPORT(S) NUMBER	List every passport whose stamps you copy, old and new.	X0000000, X1111111

Part 2 — Entry and exit dates of the current year (PART 2)

On the form	What to write	Example
Entry dates ENTRY DATES dd/mm/yyyy	Every date you entered Cyprus this year, one per row, in order.	05/01/2026
Exit dates EXIT DATES dd/mm/yyyy	The matching exit date on the same row. Leave the last exit empty if you are in Cyprus now.	20/02/2026

Part 3 — Entry and exit dates of the previous year (PART 3)

On the form	What to write	Example
Entry dates ENTRY DATES dd/mm/yyyy	Every date you entered Cyprus last year.	15/03/2025
Exit dates EXIT DATES dd/mm/yyyy	The matching exit date on the same row.	01/08/2025

Declaration (DECLARATION)

On the form	What to write	Example
Declaration that the information is true I hereby declare that all the information contained in this application ... are true and accurate ...	You accept that the HIO may check with any government service. The form quotes Article 61 of the GHS Law: false information is a criminal offence punishable by up to 3 years in prison, a fine of up to €8,000, or both.	—
Date and signature Date / Signature	Date in dd/mm/yyyy and your signature.	23/10/2026 / M. Example

Common mistakes

Listing only some trips. The instructions say ALL entry and exit dates for the current and previous year.
Forgetting an old passport. If you changed passports, the stamps from all of them count.
Copying only stamped pages. The form asks for every page, including blank ones.
One form for the whole family. Each applicant needs a separate form.
Writing dates as month/day. The form requires dd/mm/yyyy.

Questions

Why does GESY ask for my entry and exit dates?

GESY covers ordinary residents of the government-controlled areas. The dates and passport copies help the Health Insurance Organisation check your ordinary residence.

What if my passport has no stamps, for example travel within Schengen?

The form only asks you to list the dates and attach all passport pages. Ask the HIO on 17000 what other evidence it accepts for trips without stamps.

Which years do I fill in?

The current year in Part 2 and the previous year in Part 3.

What happens if I give wrong dates?

The form quotes Article 61 of the GHS Law: knowingly false information is a criminal offence, with up to 3 years in prison, a fine up to €8,000, or both.

Sources

Figures checked 23 October 2026. Rules change: we confirm them for your case before you act.

GESY entry and exit dates declaration: every field explained