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Name: Fillable Online Declaration Attesting to the Authenticity of an Individual’s Covid-19 Vaccination Record Fax Email Print - pdfFiller
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This form serves as a declaration for individuals to attest to the authenticity of their COVID-19 vaccination record as required by Executive Order No. 13G. It outlines the requirements for vaccination for state employees, including submission of proof of vaccination and adherence to federal laws regarding fraudulent vaccination records.

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How to fill out covid-19 vaccination record declaration

01

Obtain the COVID-19 Vaccination Record Declaration form from your local health authority or official website.

02

Carefully read the instructions provided on the form.

03

Fill in your personal details such as your full name, date of birth, and contact information.

04

Provide details of the vaccination(s) received, including the type of vaccine, date(s) of vaccination, and healthcare provider information.

05

Sign and date the form to certify that the information provided is accurate.

06

Submit the completed form as instructed, either online or in person.

Who needs covid-19 vaccination record declaration?

01

Individuals who wish to travel to certain destinations that require proof of vaccination.

02

Employees in workplaces that mandate vaccination records.

03

Participants in events or activities that require proof of vaccination for entry.

04

People applying for exemptions or accommodations related to vaccination status.

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What is covid-19 vaccination record declaration?

COVID-19 vaccination record declaration is a formal statement that confirms an individual's vaccination status against COVID-19, typically including the details of the vaccines received.

Who is required to file covid-19 vaccination record declaration?

Individuals who have received COVID-19 vaccinations and are required to provide proof of vaccination for travel, employment, or events may be required to file a COVID-19 vaccination record declaration.

How to fill out covid-19 vaccination record declaration?

To fill out the COVID-19 vaccination record declaration, individuals should provide personal information such as name, date of birth, and contact information, along with details of their vaccination, including vaccine type, dates of administration, and the administering authority.

What is the purpose of covid-19 vaccination record declaration?

The purpose of the COVID-19 vaccination record declaration is to verify an individual's vaccination status to ensure compliance with health and safety regulations, facilitate travel, and enhance public health monitoring.

What information must be reported on covid-19 vaccination record declaration?

The information that must be reported on the COVID-19 vaccination record declaration typically includes personal identification details, vaccine type, dates of vaccination, and any relevant identification numbers associated with the vaccination.

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