Covid Vaccination Certificate: Request for correction

Does your vaccination certificate contain incorrect information or is it unavailable? Submit a complaint using the form below.

You can also call 02/214.19.19 to ask for the certificate to be sent to you or to submit a request if there is a problem with your vaccination certificate.

Please Fill Out This Form

"*" indicates required fields

Name*

First Last

Email*

Phone*

Zip / Postal Code*

Date Of Birth*

National Identification Number*

How can we help you?*

Which dose is the subject of this claim?*

When did you receive your first dose?*

Where did you receive your first dose?*

What is the doctor's name that gave you your first dose?*

What is the Vaccination Stand name where you received your first dose?*

Specify the name of the elders home or care institute for your first dose*

Name the center where you got your first dose*

Name the hospital where you received your first dose*

First Dose Vaccine Type*

When did you receive your second dose?*

Where did you receive your second dose?*

What is the doctor's name that gave you your second dose?*

What is the Vaccination Stand name where you received your second dose?*

Specify the name of the elders home or care institute for your second dose*

Name the center where you got your second dose*

Name the hospital where you received your second dose*

Second Dose Vaccine Type*

When did you receive your third dose?*

Where did you receive your third dose?*

What is the doctor's name that gave you your third dose?*

What is the Vaccination Stand name where you received your third dose?*

Specify the name of the elders home or care institute for your third dose*

Name the center where you got your third dose*

Name the hospital where you received your third dose*

Third Dose Vaccine Type*

Kindly add more details to be able to assist you*

This field is for validation purposes and should be left unchanged.