INTERNATIONAL COVID-19 VACCINATION CERTIFICATE

SERTIFIKAT VAKSINASI COVID-19 INTERNASIONAL

Number / Nomor :
382712630

DETAILS / RINCIAN

Full Name
ANIS SUMARNI
Nama
Lengkap

   National Identity Number
3276054111970004
NIK

Passport Number
C0746882
No.
Passport

Date of Birth 1997-11-01

For further details, please visit Tanggal
Lahir
https://verify.kemkes.go.id

VACCINATION DETAILS / RINCIAN VAKSINASI

Date of vaccination
Dose Number
Country of Vaccination
Vaccine Manufacturer
Type
Batch ID

Tanggal Vaksinasi Dosis ke Negara /Tempat Vaksinasi Jenis Vaksin Type Batch ID

07-Jul-2021 First / Pertama Indonesia CoronaVac 1/2 24002421

04-Aug-2021 Second / Kedua Indonesia CoronaVac 2/2 24004021

10-Feb-2022 Third / Ketiga Indonesia AZD1222 Additional NM0004

Vaccination is to protect ourselves and our families, neighbors and

protect Indonesian people and people worldwide.

Vaksinasi
melindungi diri kita, keluarga kita, tetangga dan melindungi rakyat
Indonesia dan manusia di seluruh dunia.

World Health Organization Digital Documentation for COVID-19

Certificates Format