SensiiRERA RAY) Be Rar a nomen pon we ogres reat pene} 09 201 95 RRA USANA IRAE (108 VA EA MIRA) 4 Sall-Deciored COVID-19 Vaccination Record (Including Non-local Vaccination Information) “FMB M Download Date o7a2 20221606 FARINA KURNAWAT PHINEAS FF WN Identity Document No. WX593463(8) M8 First Dose ‘YEE Vaccination Date 25.07-2022 SEMA Vaccine Name ‘CoronaVac HAVE / COVIO-19 Vaccine (Vero Cell, Inactivated M ELTAREL USGL (Vero I), IGE Vaccine Manufacturer SLNHAGH (WR) /LAUREMRAAMDN / WR (XI) LUAIAMAN Sinovac/Sinovac Blotech Co, Ltd /Sinovac (Osan) Vaccine Technology Co. Ltd ‘R04 RFEEER /M2UE Country/Region of Vaccination |DREAE/ndonesia S=tt Second Dose MIEN Vaccination Date 30-08-2021 SBM Vaccine Name CCorenaVec RIE / COVID-19 Vaccine (Vero Cel) Inactivated BIRZIRA WEEE (Vero HR) SG1SEm Vaccine Manufacturer SMBS (GA) /LRAASANEAMAE / HA ( XA) UERMAMAM Sinovac /Sinovoc Biotech Co, Ltd / Sinovac (Dalian) Veccine Technology Co. Ltd ‘SiH HE/121K Country/Region of Vaccination EIREHES/ Indonesia 8t Third Dose ‘RHEE Vaccination Date 01-12-2022 SBTE IA Vaccine Name (CoronaVec HIERIE / COVIO-19 Vaccine (Vero Cell, Inactivated REEIEIRR IS TH (Vero HE) S14 SEAN Vaccine Manufacturer SEAMS (AT) /SLRUREREAM MDT / HR ( XIE) EMIEARAE Sinovac /SinovacBiatech Co, Ltd / Sinovec (Dalian) Voccine Technology Co. lta ‘Br REIL /S80E Country/Region of Vaccination 87 /Hong Kong S098 Fourth Dose 19K Vaccination Date ‘BZI Vaccine Name WA ‘Biid EI Vaccine Manufacturer ‘80 /RUEEER/eE Country/Region of Vaccination =.EHH Fifth Dose HIRE Vaccination Date: 5M GW Vacs Name wah SAMERM Veccine Manufacture (SB RUR ELE Country/Region of Veccination ‘WLR201 FAA EN Previous infection of COVIO-19 aN ACME TSP AMMeNREG A: (AOREUR AMO) (63998) Te WOOECH:-O2e TRNRAR! ae ANI F FoR MONEMOAR - SIORRARAS AED GROEZVAMER [As you have received COVID-19 vaccination outside Hong Kong. this ‘Vaccination Record QR Code Is generated based on the veccination information You have declare to he HESARG to facta you to comply wth te Varine es rangement n Hong Kong. You may provide ths QR code a hardcooy conveniently, ¥6 the QR code: “ This QR code cannat be shared for use by others. Please note that this QR code: should neither be used as medical records nor for travel purposes. The giving of false information will lead 1o respective legal consequences. Itis an offence any person to prowde information that is false or rsleading n a material particular according to relevant regulations ane direchont under the Prevention ‘and Control of Disease Ordinance (Cap $99) and other relevant Hong Kong tion, On conviction, you are lable to a fine and imprisonment. Tha QR ‘Code, based on self-declared information is not a proot ofthe authencc ty ot your non-local vaccination records, You may be required to provide your Sigel non cal acnaton ecaswd or ecvey eons RUS—S9SNEURURAPERRNEM sCRNRCR MER ARSKRER ARES AMNNN, ZR RRA TE you have declsred your non-local COVID-19 infection record together with the above, this Vaccination Record QR code tAleady coven your ecovey stator and can be used for Vaccine Pass ‘You da not need to make a separate declaration.