Do not apply for COVID-19 vaccine.

My name is _ _ _ years old, and my home address is _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.

Due to my _ _ _ _ _ _ _ _ reasons and my physical reasons, after consulting with the doctors in the hospital, I am now writing this application for not being vaccinated with COVID-19 vaccine. I hope the leader will give me approval.

I am here to convey

Salute!

Remarks: 1. Hospital medical records prove that:

Applicant:

Year-month-day

Legal basis: Article 45 of the Vaccine Management Law: When carrying out vaccination, medical and health personnel should inform the recipients or their guardians of the varieties, functions, contraindications, adverse reactions, on-site observation and other precautions of the recipients, ask the health status of the recipients and whether there are any contraindications for vaccination, and record the information truthfully. The recipient or his guardian shall truthfully provide the health status and vaccination contraindications of the recipient. If vaccination is prohibited, medical and health personnel shall put forward medical advice to the recipient or his guardian, and record the medical advice truthfully.