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Applicant Details
Given Name(s)
*
Surname
*
Date of Birth
*
Day
Month
Year
Nationality
*
British Citizen
British Subject
British Virgin Islands
British Overseas Citizen
British National Overseas
British Dependant Territories Citizen
British Protected Person
Afghanistan
Albania
Algeria
Andorra
Angola
Anguilla
Antigua & Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia Herzegovina
Botswana
Brazil
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comores Islands
Congo, Dem. Rep. Of
Congo, Republic of
Cook Islands
Costa Rica
Cote D'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Dutch Caribbean
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Fiji
Finland
France
French Guiana
French Guinea
French Polynesia
French West Indies
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guinea Bissau
Guinea, Republic of
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea - North
Korea - South
Kosovo
Kuwait
Kyrgystan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Mocronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Not Applicable
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Reunion Island
Romania
Russia
Rwanda
Samoa (American)
San Marino
Sao Tome & Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Sudan
Spain
Sri Lanka
St Kitts and Nevis
St Lucia
St Vincent and the Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan (Republic of China)
Tajikistan
Tanzania
Thailand
The Vatican (Holy See)
Tibet
Timor-Leste
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Nations Laissez Passer
United States
Uruguay
US Diplomatic Passport
Uzbekistan
Vanuatu
Venezuela
Vietnam
Western Samoa
Yemen
Zambia
Zimbabwe
Passport Number
*
Photo Identification
You
MUST
provide a copy of your photo identification. This can be passport, National ID card or driving licence. If you do not we cannot proceed with arranging your PCR test until you have forwarded this on to us.
Max. file size: 16 MB.
Email Address
*
Telephone Number
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Proposed Date of Travel
*
DD slash MM slash YYYY
Destination Country
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Time of Departure
*
Hours
:
Minutes
AM
PM
Length of Stay
*
(Days)
Service Options
Would you like to opt for the postal test or the in-clinic test?
*
Postal
In-clinic
Service Type
Same Day
48 Hour
Address you would like your PCR Travel Test sent to
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Centre location
*
PLEASE NOTE:
Weekend appointments are only available at Birmingham and London.
Should the 72 hours prior to your travel date include a Sunday, you
MUST
opt for the 24 hour service to ensure your results come back in time. The 24 hour services are
ONLY
available in Birmingham and London.
Belfast
Birmingham
Brighton
Cardiff
Edinburgh
Glasgow
Hull
Leeds
Liverpool
London (Central)
London (Gatwick)
London (Heathrow)
Manchester
Middlesbrough
Newcastle
Norwich
Peterborough
Sheffield
Southampton
Preferred appointment time
*
PLEASE NOTE
: the time you select MUST be within 72 hours of your travel time.
Next available
09:00-10:00
10:00-11:00
11:00-12:00
12:00-13:00
13:00-14:00
14:00-15:00
15:00-16:00
Preferred appointment time
*
PLEASE NOTE
: the time you select MUST be within 72 hours of your travel time.
09:00-10:00
10:00-11:00
11:00-12:00
11:00-13:00
Payment
Price Breakdown
Postal
PCR Test Service
Appointment Centre
Test fee
Service Fee
*with Mercury Holidays Customer Discount*
VAT
Total
Postal PCR Test
£99.00
£0.00
£0.00
£111.95
Same Day
PCR Test Service
Appointment Centre
Test fee
Service Fee
*with Mercury Holidays Customer Discount*
VAT
Total
Birmingham
£195.00
£0.00
£0.00
£229.95
Liverpool
£185.00
£0.00
£0.00
£219.95
London Central
£144.00
£0.00
£0.00
£178.95
London Gatwick
£144.00
£0.00
£0.00
£178.95
London Heathrow
£144.00
£0.00
£0.00
£178.95
Manchester
£185.00
£0.00
£0.00
£219.95
48 hour
PCR Test Service
Appointment Centre
Test fee
Service Fee
*with Mercury Holidays Customer Discount*
VAT
Total
Belfast
£125.00
£0.00
£0.00
£125.00
Birmingham
£125.00
£0.00
£0.00
£125.00
Brighton
£125.00
£0.00
£0.00
£125.00
Cardiff
£125.00
£0.00
£0.00
£125.00
Edinburgh
£125.00
£0.00
£0.00
£125.00
Glasgow
£125.00
£0.00
£0.00
£125.00
Hull
£125.00
£0.00
£0.00
£125.00
Leeds
£125.00
£0.00
£0.00
£125.00
Liverpool
£125.00
£0.00
£0.00
£125.00
London Central
£119.00
£0.00
£0.00
£119.00
London Gatwick
£119.00
£0.00
£0.00
£119.00
London Heathrow
£119.00
£0.00
£0.00
£119.00
Manchester
£125.00
£0.00
£0.00
£125.00
Middlesbrough
£125.00
£0.00
£0.00
£125.00
Newcastle
£125.00
£0.00
£0.00
£125.00
Norwich
£125.00
£0.00
£0.00
£125.00
Peterborough
£125.00
£0.00
£0.00
£125.00
Sheffield
£125.00
£0.00
£0.00
£125.00
Southampton
£125.00
£0.00
£0.00
£125.00
Same Day
PCR Test Service
Appointment Centre
Test fee
Service Fee
*with Mercury Holidays Customer Discount*
VAT
Total
Birmingham
£195.00
£0.00
£0.00
£229.95
Liverpool
£185.00
£0.00
£0.00
£219.95
London Central
£144.00
£0.00
£0.00
£178.95
London Gatwick
£144.00
£0.00
£0.00
£178.95
London Heathrow
£144.00
£0.00
£0.00
£178.95
Manchester
£185.00
£0.00
£0.00
£219.95
48 hour
PCR Test Service
Appointment Centre
Test fee
Service Fee
*with Mercury Holidays Customer Discount*
VAT
Total
Belfast
£125.00
£0.00
£0.00
£125.00
Birmingham
£125.00
£0.00
£0.00
£125.00
Brighton
£125.00
£0.00
£0.00
£125.00
Cardiff
£125.00
£0.00
£0.00
£125.00
Edinburgh
£125.00
£0.00
£0.00
£125.00
Glasgow
£125.00
£0.00
£0.00
£125.00
Hull
£125.00
£0.00
£0.00
£125.00
Leeds
£125.00
£0.00
£0.00
£125.00
Liverpool
£125.00
£0.00
£0.00
£125.00
London Central
£119.00
£0.00
£0.00
£119.00
London Gatwick
£119.00
£0.00
£0.00
£119.00
London Heathrow
£119.00
£0.00
£0.00
£119.00
Manchester
£125.00
£0.00
£0.00
£125.00
Middlesbrough
£125.00
£0.00
£0.00
£125.00
Newcastle
£125.00
£0.00
£0.00
£125.00
Norwich
£125.00
£0.00
£0.00
£125.00
Peterborough
£125.00
£0.00
£0.00
£125.00
Sheffield
£125.00
£0.00
£0.00
£125.00
Southampton
£125.00
£0.00
£0.00
£125.00
Service Option
Postal Test
Service Option
Birmingham
Liverpool
London (Central)
London (Gatwick)
London (Heathrow)
Manchester
Service Option
Belfast
Birmingham
Brighton
Cardiff
Edinburgh
Glasgow
Hull
Leeds
Liverpool
London (Central)
London (Gatwick)
London (Heathrow)
Manchester
Middlesbrough
Newcastle
Norwich
Peterborough
Sheffield
Southampton
How would you like to receive your appointment confirmation?
*
Email
1st Class Post
2nd Class Post
Total
£ 0.00
Credit Card
*
Card Details
Cardholder Name
Billing Address
*
Same as home address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
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Please tick to confirm you you have read, fully understood and agree to the following:
*
PLEASE NOTE:
Weekend appointments are only available at Birmingham and London.
Should the 72 hours prior to your travel date include a Sunday, you
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opt for the 24 hour service to ensure your results come back in time. The 24 hour services are
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I, the applicant, hereby certify that I have read, or have had read to me, all the questions and statements on this application and understand all the questions and statements on this application. The answers and information furnished in this application are true and correct to the best of my knowledge and belief.
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