INTERNATIONAL COVID-19 VACCINATION CERTIFICATE

SERTIFIKAT VAKSINASI COVID-19 INTERNASIONAL

Number / Nomor :
995385091

DETAILS / RINCIAN

Full Name
ERWIN ARJAYANI SUPARWANTO
Nama
Lengkap

   National Identity Number
3372015509780006
NIK

Passport Number
C0540083
No.
Passport

Date of Birth 1978-09-15

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

28-Aug-2021 First / Pertama Indonesia CoronaVac 1/2 24202521

30-Dec-2021 Second / Kedua Indonesia CoronaVac 2/2 202109195G

28-May-2022 Third / Ketiga Indonesia AZD1222 Additional ACB5323

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