Data Collection for vaccination
Name of the Department *
Name of the Employee *
Type of Employment *
Designation *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Age Group *
Mobile Number *
ID card Type *
ID card number (AADHAR card / Voter Card / PAN card) *
Covid Vaccination Status *
Type of Vaccine (keep blank if not done)
Clear selection
Date of 1st dose of vaccine (keep blank if not done)
MM
/
DD
/
YYYY
Date of 2nd dose of vaccine (keep blank if not done)
MM
/
DD
/
YYYY
Write the name of the district of your permanent address *
Write the Pincode *
Addition Remarks (if any)
Submit
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