If you are interested in procuring the COVID vaccine, please fill in the following details and our team will be in touch with you with more details.
Please note that this is just an interest form to help us build adequate supply chain capabilities at our end and is in no way a guarantee on delivery of the vaccine. This is subject to any govt guidelines or conditions
Number of Vaccines Required
Number of Family Members and their age
Is there any chronic disease in the family (like diabetes, heart disease, etc)? If any please give details.
Send me a copy of my responses.
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This form was created inside of ITS-DOST.