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COVID-19

vaccination
certificate

EVAX registration number : 041744491

Surname : MOHAMED HABIB SELLEM National Identity card : 14432142


and
Forename

Identifier type : Citizen holding a national identity card

Date of Birth : March 14, 2003

Vaccination certificate reference : fde277bb-acbd-4473-a1dd-be556fa8bab0

Vaccine name 1st dose : MODERNA Batch number 1st dose : 025D21A

Vaccination date : August 15, 2021

COVID Date : July 15, 2021 Having contracted the Covid (based on
your declaration), a single dose is
recommended to you.

Vaccination Center : Lycèe Mahmoud Messaidi Nabeul

Electronic stamp
:

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