Vaccination Drive for KENT Mumbai Employees

Availability confirmation
Thank you for participating in the vaccination survey. Final confirmation has been considered.
This is just to reiterate the fact that once the numbers have been confirmed we will not be able
to retract it back due to procurement and availability of the vaccines. Please go through the
below information carefully and confirm the declaration for both SELF and FAMILY.

*1. Mention your Full Name –

*2. Enter your Workday ID –

*3. Enter your official Email ID –

*4. Kindly read the below information carefully, before accepting the declaration.

1. This a voluntary activity opted by you for self and family (as applicable). I know the
purpose and potential benefits of Covid-19 vaccination and assume full responsibility as regard
any consequences / side-effects / contingency of the vaccination associated with vaccine.

2. Company makes no warranties, express or implied, including but not limited to, implied
warranties of merchantability or fitness for a particular purpose regarding the vaccine or its
effectiveness.

3. I, for myself and family members hereby agree to release and hold harmless the
Company, its subsidiaries, affiliates and all related parties from and against any and all
contingencies, consequences, demands, damages, losses, costs, expenses, obligations,
liabilities, claims, actions and cause of action (whether any of which is groundless or otherwise)
of any nature whatsoever by reason of or resulting, in any way from any and all acts, accidents,
events, occurrences, omissions and the like related to, or raising out of, directly or indirectly
receiving this COVID-19 vaccine.

4. If you or your family is taking booster dose, there should be a gap of 24 weeks (6 months
from the date of 2nd dose) as per the govt. guideline.
5. Pregnant Women are not eligible for vaccination. Lactating mothers should have
prescription from their doctor stating they could take vaccination (this document has to be
carried to the venue).

6. You declare that you have gone through guidelines mentioned by the Ministry of Health
and Family Welfare, govt. of India.

(https://www.mohfw.gov.in/covid_vaccination/vaccination/faqs.html) and are hereby

confirming the eligibility for yourself and your family member.

7. You / family member are currently not showing covid-19 related symptoms & must not
be tested positive in past 3 months.

☐ Yes, I am aware and confirming my participation

☐ I am withdrawing participation after reading the above points made aware, due to ineligibility.

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