Appx'A'

1. Beneficiary Details

Pers No
/cq77& L
Rank & Name
Gender & Birth Yr lillL€ / 76 f
Unit & Fmn Ha /6AR (&sr)
AADHAAR/ PAN/ Driving License No 7662 zsez r6>q
Mobile No

2. Vaccination Details

Vaccination Name
covtsutElb
Date of 1't dose with batch No oL lfhr\o\t
Date of 2nd dose with batch No zt AFrzo>r 4t>t z o 5r
Name of nearest CVC & registration lD

3. Certificate is required for the purpose of Tru uEL 2 ofFrc14l fqRrures

*
(s ignature of the lndl)

COUNTERSIGNED