APPLICATION TO CONVERT A FOREIGN VACCINATION CERTIFICATE
INTO A FRENCH COVID CERTIFICATE
I, the undersigned,
SURNAME:...................................................................................................
............
First
name(s): ....................................................................................................
.....
Address (in country of residence
abroad): ....................................................................................................
................................................................................................................
................................................................................................................
................................ ........ ........ ........ ........ ........ ........ ........ ........ ........
........ ........
Country in which the vaccine was administered (if other than the country of
residence):..................................................................................................
.....................
Date of arrival in
France: .....................................................................................
Date of departure from France: ………………………………………………………………………………………
E-mail
address: .....................................................................................................
.....
Te l e p h o n e n u m b e r ( p l e a s e i n c l u d e c o u n t r y / a r e a
code): .......................................................................................................
................
Hereby request that my COVID-19 vaccination certificate, issued by the competent
authorities in my country of residence, be converted into a French COVID certificate. I
certify that the vaccine I received abroad is recognized by the European Medicines Agency
(EMA).
To that end, I hereby attach with this dated and signed form:
• A copy of my photo ID (valid passport)
• A copy of the vaccination certificate issued in my name by the competent authorities in
my country of residence, clearly stating the type of vaccine used
• My travel ticket
