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New York | London | Amsterdam | Hong Kong
inquiry@vaxfi.com
Mon - Fri : 0900 to 1800

VAX PASSBOOK FORM

VAXFI - A Vaccinated Certificate verified portal

VAX PASSBOOK FORM

VAX PASSBOOK APPLICATION

Please give all the information needed below.

Traveler Information *

International Travel Document

Name *

First

Middle

Last

Email *

Date of Birth *

Phone *

Address *

Address Line 1

City

State / Province / Region

Country

Dependent Traveler Information

Traveler Information

First

Last

Relationship

Traveler Information

First

Last

Relationship

Travel Itinerary

Country before arrival at international destination (Note: Select “None” if you are not arriving from another country)

Address

Address Line 1

City

State / Province / Region

Country

Date of Arrival *

Planned date of departure *

How did you arrive to your destination?

Airplane
Train
Car
Other

COVID-19 Monitoring & Affirmation

Did you get tested? *

Yes
No

If Yes, kindly state which laboratory/agency?

Have you been vaccinated?

Yes
No

If Yes, kindly state which laboratory/agency.

COVID-19 Test and Vaccination Status

I certify that at least one of the following is true: (Choose 1) *

I am quarantining for 14 days
I plan to get a COVID-19 test at my destination and will quarantine for a period of 14 days or until I receive a negative test result, whichever comes first (NOT APPLICABLE to travelers from outside the country or who must quarantine for 14 days). For more information on COVID testing, visit https://www.cdc.gov/coronavirus/2019-ncov/vaccines/index.html
I was tested for COVID-19 within 72 hours of my arrival in my destination and;
My test result was negative; or
I will remain in quarantine for a period of 14 days or until I receive a negative test result; or
I meet a defined exemption criteria (public health, public safety or healthcare workers; anyone traveling for medical treatment, to attend funeral or memorial services, to obtain necessities such as groceries, gas or medication, to drop off or pick up children from day care or to anyone who must work on their boats).

Attestation

Checkboxes *

By submitting this form, I hereby attest, under penalty of law, that all the information I have provided is true and accurate to the best of my knowledge.

Easier global travel will become a reality with one or more COVID-19 vaccines being available before the end of 2020. Before you travel, you’ll need to be tested, and when the vaccines are available, you’ll need to get vaccinated. The IHAWO provides a platform for you to register and receive proof of your negative COVID-19 test and vaccination with the certificate stamp on your VAX Passbook.

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(©) 2020 Vaxfi Health, a Vaccinated Certificate Service Center For Global Health & Travel. VAXFi, VAXFied, VAX Passbook & VAX PPT Are All Trademarks And Servicemarks Of International Health And Wellness Organization (IHAWO) LLC. All Rights Reserved.

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