EMPLOYEE REGISTRATION Form

Declaration *

I hereby declare that the employee / list of employees which I have submitted for Covid vaccination is / are working in my institution and they belong to the category of Frontline worker in Covid care. I also declare that the above employee/ employees belong to the age group between 18 years and 44 years.
"I am aware that providing false information is an offence and that I am personally responsible for the above declared information".

Upload Employee Details Download sample excel format Maximum 100 records are allowed to upload at a time. You can upload any number of times based on your employees. Keep the Heading column and remove sample data. Please fill the correct values as in the format given in sample data and upload.
Preferred Vaccination Center *
Preferred Date*
Preferred Time slot *
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:: Request for Vaccination ::

Declaration *