Covid-Related Services

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I hereby declare that I am above 18 years of age.
I hereby declare that all entries and information provided by me in this form are true and correct*
I acknowledge that I have read and understood the Privacy Policy and agree to the collection, use and handling of my Personal Data according with the policy.
I acknowledge that by taking this vaccine, I will not be part of the Vaccine Injury Financial Assistance Program (VIFAP) introduced by the Government*