Negative certificate issuance request

English

Name

Email

Negative Result (Image or PDF)

Date of Specimen Collection

Date of Test

Name of Laboratory or Medical Institution
*If you use Rapid Test Kits, Name of Manufacturer and kit

Methods of Inspection
PCRTMALAMPAntigen test

Vaccinated (1st)
PfizerAstraZenecaModernaJohnson & JohnsonSanofiOther

Date of Vaccination (1st)


Vaccinated (2nd)
PfizerAstraZenecaModernaJohnson & JohnsonSanofiOther

Date of Vaccination (2nd)

History of new coronavirus infection (Name of Disease:COVID-19,Name of Virus:SARS-CoV-2)
NeverYes

Confirmed Date of Positive