On this page, you can upload and submit:

  • A Supporting Evidence Form;
  • If applicable, other documents in support of your Claim Form and/or the Supporting Evidence Form;
  • Invoices for medical expenses;
  • If applicable, power of attorney or notarised statement confirming that you are the legally authorised parent, guardian, heir or legal representative of the Patient;
  • Forms relating to an appeal of your rejected Claim or an appeal of a denial of your Receivable Claim, and your Notice of Appeal of Rejected Claim Form (Schedule 4)..

In order to be considered a complete Claim, your Claim will need the Supporting Evidence Form and other required documents to be submitted in addition to the Claim Form.

First, please upload all attachments through the relevant sections of this page. Once you have finished uploading all your attachments, click “SUBMIT” at the bottom of this page. This will submit all the attachments that you have provided at the same time.

Where can I find my Claim number?

  • If you submitted a Claim Form online, your Claim number was displayed on the confirmation page after the online submission. It will have also been sent to your email address provided in your Claim (if an email address was provided).
  • If you: (1) submitted a Claim Form via email; (2) uploaded and submitted a manually completed Claim Form via the Upload printed Claim Form; or (3) sent your Claim Form by regular mail, then the Scheme’s Administrator will have sent the Claim number to the Claimant’s email address or mailing address given in their Claim.
  • If you need help in obtaining your Claim number, please contact the Scheme’s Administrator at [email protected] for assistance.
Claimant Name(Required)


NOTE: Under each category below, you can only upload a certain number of documents (as specified for each category) at the same time. Once the maximum number of documents you can upload at the same time is reached, please return to this page to upload any additional documents you may wish to submit. You can repeat this operation as many times as necessary.
Please upload duly completed and signed “Supporting Evidence Form” using Schedule 3. The Supporting Evidence Form must be completed and signed by one or more Registered Healthcare Professional(s).
Drop files here or
Max. file size: 2 MB, Max. files: 1.
    Please upload invoices, receipts or other proof of payment of any medical expenses (including Hospital fees) that were required as a consequence of the Injury or illness suffered by the Patient for which this Claim is made.
    Drop files here or
    Max. file size: 2 MB, Max. files: 3.

      If the Patient:

      • has died,
      • is a child, or
      • is disabled or otherwise lacks legal capacity to submit this Claim for himself/herself

      then the person submitting this Claim for the Patient must please submit a power of attorney and/or statement notarized by a notary public or other Notary Official confirming that:

      • the person submitting the Claim for the Patient is the legally recognized parent, guardian, heir or legal representative of the Patient, as the case may be; and
      • if the Patient has died, that the person submitting this Claim on behalf of the Patient:
        • is the duly-authorized and legally-recognized representative of all legal heirs of the Patient, as listed in the power of attorney or notarized statement; and
        • has all necessary rights, powers and authority to represent, act for and bind all of such legal heirs; and
        • there are no other legal heirs of the Patient other than those legal heirs who are listed in the power of attorney or notarized statement.
      Drop files here or
      Max. file size: 2 MB, Max. files: 1.
        If applicable, please upload any other documents or information in support of your Claim Form or Supporting Evidence Form.
        Drop files here or
        Max. file size: 2 MB, Max. files: 3.
          Note: You can only upload a Notice of Appeal of Rejected Claim Form if your initial Claim has been rejected. Please do not upload a document here if your initial Claim has not been rejected.
          Drop files here or
          Max. file size: 2 MB, Max. files: 2.
            Note: You can only upload a Notice of Appeal of Denied Receivable Claim Form if your Receivable Claim has been denied. Please do not upload a document here if your Receivable Claim has not been denied.
            Drop files here or
            Max. file size: 2 MB, Max. files: 2.
              Supporting Evidence

              The supporting evidence, using the form in Schedule 3 of the Scheme’s Protocol, required to evaluate a Claim and that shall include:

              1. detailed medical documentation from a Registered Healthcare Professional describing the Injury and medical treatment required as a result of the Injury, together with details of any Hospitalisation or prolonged Hospitalisation, including but not limited to admission and discharge records;
              2. a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
              3. a statement from the Registered Healthcare Professional that the Injury was, in the Registered Healthcare Professional’s opinion, the result of the Vaccine or its administration;
              4. certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
              5. in the case of death, a death certificate and any other documentation available from a Registered Healthcare Professional of the cause and manner of death; and
              6. any further evidence that the Administrator may deem necessary to adjudicate the Claim and/or Receivable Claim, as applicable, guided, as appropriate, by the Scientific Advisory Committee, the Review Panel, and/or the Appeals Panel.
              Claim

              A written claim for compensation completed by a Claimant, using the Claim Form approved by and provided by the Administrator, as set forth in Schedule 2 of the Scheme’s Protocol, which must be accompanied by all Supporting Evidence.

              Patient

              A beneficiary of a Vaccine (i) procured and/or delivered by UNICEF on a Participating Country’s behalf; (ii) donated to a Participating Country through UNICEF; or (iii) formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF) who claims or in respect of whom it is claimed that he or she has suffered or sustained a Serious Adverse Event which is associated with a Vaccine or its administration, and which, in turn, has resulted in an Injury.

              Receivable Claim

              Any duly completed Claim for compensation (i) that is accompanied by all Supporting Evidence, (ii) that is filed/submitted by a Claimant prior to the end of the Reporting Period with the Administrator, and (iii) that is found by the Administrator, and/or by the Administrator’s Vice President of Risk Consulting to be receivable as provided in Section 4 or Section 7 of the Scheme's Protocol.

              Notice of Appeal of Rejected Claim (denial of receivability)

              An appeal filed by a Claimant, following the denial of receivability of his or her Claim by the Administrator, in accordance with the procedure described in Section 7 of the Scheme’s Protocol and using the form in Schedule 4 of the Scheme’s Protocol.

              Scheme

              The Covid-19 Vaccine Facility No-Fault Compensation Scheme, established to provide fair compensation to eligible vaccine recipients who suffer a Serious Adverse Event related to a COVID-19 vaccination that has been either:

              • procured and/or delivered by UNICEF on a Participating Country’s behalf;
              • donated to a Participating Country through UNICEF; or
              • formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF),

              as detailed in the Scheme Protocol and its Schedules.

              Administrator

              ESIS, Inc., the claims Administrator appointed to manage and administer the Program, including, but not limited to, the receipt and registration of Applications, distributing acknowledgements of receipt of Applications, setting financial reserves for Receivable Claims, review of Applications, Supporting Evidence, and other documents to assess receivability, assessing Receivable Claims, and approve or deny, as the case may be, Payment for compensation, in accordance with the terms of the Program's Protocol.

              Claimant

              Any individual, who meets all of the following requirements:

              1. is a Patient who was administered a Vaccine (or in the event the Patient has died, is a child, or is disabled or otherwise lacks the legal capacity to submit a Claim for himself or herself, is an individual who is a duly authorised heir (in the case of death), parent, legal guardian or other legal representative of the Patient); and
              2. is, or is duly authorised to represent, a Patient who has sustained an Injury which, in the opinion of a Registered Healthcare Professional, is deemed to have resulted from a Vaccine or its administration; and
              3. the Vaccine was administered before its Scope of Coverage Endpoint (as indicated in Schedule 1 of the Scheme’s Protocol); and
              4. has submitted a Claim for compensation, using the prescribed form in Schedule 2 of the Scheme’s Protocol, together with all Supporting Evidence, using the prescribed form in Schedule 3 of the Scheme’s Protocol to the Administrator, following the procedures described in the Scheme’s Protocol, and provided that this Claim is submitted: (a) in full observance of the waiting period of 30 days referred to in Section 1(c) and in Schedules 2 and 3 of the Scheme’s Protocol; (b) before the end of the Reporting Period; and (c) otherwise within the time limits set forth in Section 4 of the Scheme’s Protocol; and
              5.  has not received any prior payment from any other public source, including from any governmental or publically funded no-fault compensation scheme, as compensation for the Injury; and
              6. is not eligible to receive compensation from any other source for the Injury, or if eligible for such compensation, discloses the nature and full extent of such eligibility; and
              7. has no pending lawsuits or claims for compensation for the Injury; and
              8. agrees not to seek or make any claims for compensation from any other public source, including from any governmental or publically funded no-fault compensation scheme, for the Injury for as long as the Claim, and/or Receivable Claim, as applicable, is pending with the Scheme; and
              9. is not and does not represent a Patient in respect of whom the Administrator is by any applicable sanctions regime, including any UN Security Council sanctions regime, precluded from accepting a Claim and/or paying compensation under the Scheme.
              Registered Healthcare Professional

              Any healthcare professional, including physicians, surgeons, nurses, midwives, nurse practitioners, physicians’ assistants, psychiatrists, psychiatrists, physical therapists, occupational therapists, dentists, and pharmacists, who is duly licensed or legally authorised to practice the profession in the country in which the Patient resides and received the Vaccine, or in the case of birth defects, where the Patient’s mother resides and received the Vaccine.

              Hospital

              A public or private institution which: (1) is licensed or otherwise formally recognised as a hospital, clinic or other healthcare facility by the government of the relevant country where it is located; (2) provides 24-hour medical, surgical and/or nursing care or treatment under the supervision of licensed physicians, surgeons, nurses and/or other healthcare professionals; and (3) has the capacity to provide room and board to patients resident overnight.

              Injury

              Serious bodily injury or illness suffered or sustained by a Patient that:

              1. requires Hospitalisation or prolongs an existing Hospitalisation; and
              2. results in permanent total or partial Impairment; or
              3. is a congenital birth injury or illness in an unborn or new-born child of a woman who received a Vaccine and results in permanent total or partial Impairment; or
              4. results in death.
              Notary Official

              A notary public or other public official legally authorised to provide notarisation, and/or legalisation services within the country in which the Claimant resides.

              Appeals Panel

              A three-member panel that:

              • Is comprised of 2 duly licensed physicians and 1 duly licensed nurse, who shall be appointed by the Administrator from a roster of 6 such physicians and nurses and
              • Will review all Notices of Appeal of Denied Receivable Claims filed by Claimants and determine – in accordance with the terms of the Program's Protocol — whether the Review Panel’s denial of the relevant Receivable Claim should be upheld or reversed.
              Notice of Appeal of Denied Receivable Claim

              An appeal filed by a Claimant, following the denial of his Receivable Claim by the Review Panel, in accordance with the procedure described in Section 8 of the Scheme's Protocol and using the form in Schedule 5 of the Scheme’s Protocol.