Jadavpur University                                    Database for beneficiary who have not received vaccine
As directed by the Principal Secretary, Department of Higher Education, Government of West Bengal on 19.05.2021, the database for the beneficiaries who have not received vaccine have to be prepared by today (20/05/2021) as per the proforma given below. All in-service employees (full-time/contractual/guest), including teachers, officers and all other supporting staff of all two campuses, who are aged 18 and above, are hereby requested to fill in the Google Form below positively by 4.00 PM today (20/05/2021). Please treat this as URGENT.
                                                                                                                                                                 Registrar

                                           
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District *
Full Name of the Beneficiary *
Department *
Occupation *
Pincode of workplace *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Age as on today May 20, 2021 ( in years) *
Mobile Number *
Identity Card to be shown at the time of vaccination (select one):   *
Identity Card Number, as chosen above. *
To which of the following two categories do you belong to? *
Dose of vaccination required (select one): *
In case you require Second Dose, the date of First Dose:
MM
/
DD
/
YYYY
In case you require Second Dose, the vaccine taken during the First Dose(select anyone):  
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