题型：单选填空

1. 姓名

选项： 1、选项1

题型：单选填空

2. 手机号码

选项： 1、选项1

题型：单选填空

3. 身份证号

选项： 1、选项1

题型：单选题

4. <span style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">请选择您返乡的交通方式：</span>

选项： 1、飞机, 2、高铁/火车, 3、长途汽车, 4、轮船, 5、自驾, 6、拼车

题型：单选填空

5. 请选择

选项： 1、选项1

题型：单选填空

6. <span style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">请填写自驾车或拼车的车牌号：</span>

选项： 1、选项1

题型：单选填空

7. <span style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">请问您是否持有返乡日之前7日内核酸检测证明？</span>

选项： 1、选项1

题型：上传文件

8. <span class="Qnum" style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">.</span><span style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">请上传您的健康码图片</span>

题型：上传文件

9. 请上传图片

题型：单选填空

10. <span style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">请留下您在返乡后常住处的详细地址：</span>

选项： 1、选项1

题型：单选填空

11. <span style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">您预计何时返回？</span>

选项： 1、选项1

题型：单选题

12. <span style="color: rgb(34, 34, 34); font-family: &quot;Helvetica Neue&quot;, &quot;PingFang SC&quot;, &quot;Hiragino Sans GB&quot;, HeitiSC, Helvetica, Arial, &quot;Microsoft YaHei&quot;, &quot;WenQuanYi Micro Hei&quot;, sans-serif; font-weight: 700;">预计返回的交通方式：</span>

选项： 1、飞机, 2、高铁/火车, 3、长途汽车, 4、轮船, 5、自驾, 6、拼车