The Program application materials consist of: (1) the Application Form (Schedule 2); (2) the Supporting Evidence Form (Schedule 3); and (3) the other documents required to be submitted with the Application Form and the Supporting Evidence Form. All of these application materials should be submitted together and at the same time in order for your application to be considered.
Please carefully read the How to Submit an Application instructions, which provide important information about how Program application materials should be completed and submitted.
You should wait 30 days after the Vaccine was administered to you (or to the person on whose behalf you are submitting an Application), before taking any steps towards: (a) the completion or submission of the Application Form and the Supporting Evidence Form; or (b) obtaining any of the documents that are required to be submitted with the Application Form and the Supporting Evidence Form. After this 30-day waiting period is over, you can proceed with taking these steps. Obviously, however, the 30-day waiting period does not apply in the event that the person you represent has died following the administration of a COVID-19 vaccine received through the COVAX Facility, and that person’s death is considered by a Registered Healthcare Professional to have been caused by that vaccine or its administration.
The Application Form and Supporting Evidence Form should be completed and submitted in English, French or Spanish; any form completed or submitted in any other language will be rejected. However, documents and other information required to be provided together with your Application Form and Supporting Evidence Form (as described in such forms) may be submitted in other languages. All Program forms must be duly completed, signed and dated when they are submitted, in order to be considered.
If you wish to submit the Application form and other application materials online through this website, then:
- For the Application Form, you can either:
- complete and submit the Application Form directly on this website by clicking the first link provided below; or
- first download, print and complete the Application Form on paper, and then scan, upload and submit the completed Application Form onto this website by clicking on the second link provided below;
- For the Supporting Evidence Form, you should:
- first download and print the Supporting Evidence form on paper;
- have one or more Registered Healthcare Professional(s) complete the Supporting Evidence Form on paper; and
- then scan, upload and submit the completed Supporting Evidence Form by clicking on the third link provided below. Please note that the Supporting Evidence Form cannot be completed directly on this website.
- For any other documents required to be submitted together with the Application Form and the Supporting Evidence Form, you can scan, upload and submit those documents onto this website by clicking on the fourth link provided below. Please remember that all application materials should be submitted at the same time.
- Schedule 2 – Application Form (click here to complete and SUBMIT ONLINE)
- Schedule 2 – Application Form (click here to DOWNLOAD and submit online)
- Schedule 3 – Supporting Evidence Form (click here to DOWNLOAD and submit online)
- Other documents required to be provided together with your Application, as described in the Application Form and the Supporting Evidence Form.
Please see the Printable Forms section to download and print the Application Form, the Supporting Evidence Form and other Program forms referenced above.
If you want to submit the Application form and other application materials by email or regular mail, please refer to the How to Submit an Application instructions for more information about how to do so.