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ISWAN's Vaccination Drive for Indian Seafarers
ISWAN in collaboration with Narayana Health and the Medica Group of Hospitals is facilitating a walk-in vaccine drive for Indian seafarers.

Before filling up this form please make sure that you have registered yourself on COWIN portal (www.cowin.gov.in/home). ISWAN will share details filled in the form with the hospital; once a slot has been booked, you will be notified one day prior regarding the slot date and time by ISWAN's regional team in India.

It is advised that seafarers do not contact the hospital directly and will be required to pay the following amount at the time of vaccination:
Narayana Health-
Cost per dose as at hospital starts from ₹630-750/dose

Medica Group of Hospitals-
Cost per dose as at hospital starts from ₹850-1000/dose

Please read the detailed SOP for your preferred hospitals before going ahead with the form:
1. SOP for Narayana Health Hospitals: https://bit.ly/3imjej7
2. SOP for Medica Group of Hospitals: https://bit.ly/3v2r7gm

COVISHIELD vaccine is being facilitated, which is also the only WHO approved vaccine in India as of date. Two doses are necessary and the Government's guidelines regarding the gap between two doses shall be followed.

For inquiries, contact SeafarerHelp helpline:
📧 help@seafarerhelp.org
⚡️ Facebook Messenger: m.me/ISWANSouthAsia

You can also find us directly on Facebook: facebook.com/ISWANSouthAsia/

Please note that all of the columns are required, and any changes to your input would not be possible once the form has been submitted.
Full Name (as per Aadhar Card) *
Date of Birth (as per Aadhar Card) *
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Mobile Number *
Email id *
Address (as per Aadhar Card) *
PIN Code *
Aadhar Number *
CDC Number *
CoWIN Registration/Ref Number (last 4 digits) *
Which dose are you signing up for? *
If you are signing up for your second dose, please do so only if your first dose was of Covishield and it should be more than 84 days since your first dose.
Date of first dose
Only for those who are signing up for their second dose.
MM
/
DD
/
YYYY
Preferred Location *
Do you have any comorbidities? *
Comorbidities is when a person has more than one underlying health/stroke medical related condition present in him/her. Each condition is considered as comorbidity, and sometimes comorbidities could be present in the form of physical or mental conditions. Please consult your doctor if you are not sure about your existing health conditions before taking the vaccine.
If you have selected "Yes" for any existing comorbidities, we would like you to please explain the correct Physical/Psychiatric condition.
Please read the detailed SOP for your preferred hospital before submitting the form (check the links in description below). *
SOP for Narayana Health Hospitals: https://bit.ly/3imjej7 / SOP for Medica Group of Hospitals: https://bit.ly/3v2r7gm
Undertaking: The information I have provided is accurate and complete to the best of my knowledge, and I meet the eligibility criteria to get vaccinated. I understand that no changes can be made once the form has been submitted. I am participating in this vaccination drive voluntarily and will not hold ISWAN liable in the event of any allergic or adverse reactions due to the vaccination. I will pay directly at the hospital and adhere to the government guidelines throughout the vaccination process. By submitting this form, I agree that the information provided above will be shared with the concerned Narayana Health/Medica Group of hospitals. *
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