NRI COVID-19 SECOND DOSE VACCINATION- Dakshina Kannada
(In Association with Indian Red Cross Society Dakshina Kannada & District Administration Dakshina Kannada)

NRIs who are stranded in Dakshina Kannada for Second Dose Vaccination can fill this form.

For first dose NRIs can visit nearest PHCs or Thaluk Hospitals.

NOTE: Do not fill the form twice.

Fill only if you have local address proof of Dakshina Kannada.

You will receive a call confirming your appointment.
Name *
Mobile Number *
Please Provide a working Indian Whats app number only
Passport Number *
Present Address *
Mention with District
Reason for Travelling Back??? *
Documents for proof of travel will be verified before vaccination.
Which Country you are travelling to?? *
Did you complete first dose Vaccination? *
First dose will be given only in the near by Primary Health Centers or other Vaccination Centers.
Date of First Dose *
MM
/
DD
/
YYYY
First Dose Vaccine *
AGE GROUP *
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