Frequently Asked Questions - COVID-19 Vaccine Facility No-Fault Compensation Scheme

A. About the Scheme

1. What is the purpose of the Scheme? And what does the Scheme cover?

The purpose of the Scheme is to provide no-fault compensation in full and final settlement of any claims to those individuals who suffer a Serious Adverse Event resulting in permanent impairment or death associated with the administration of a COVID-19 vaccine is 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)

A number of conditions need to be met:

in order for a claim for compensation to be receivable; and
if a claim is receivable, in order for you (or the person you represent) to be eligible for and receive such compensation.

These conditions are described in 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.

Serious Adverse Event

A serious untoward medical occurrence that (i) is sustained or suffered by a Patient following the administration of a Vaccine, and (ii) results in an Injury, as evidenced by the supporting evidence, using the form in Schedule 3 of the Scheme’s Protocol, required to evaluate a Claim and that shall include:

UNICEF

An international inter-governmental organisation established by the General Assembly of the United Nations by resolution No. 57(1) of 11 December 1946 as a subsidiary organ of the United Nations.

Participating Country

Any country participating in the Scheme as listed in Schedule 9 of the Scheme’s Protocol (as may be updated from time to time).

2. What does the Scheme not cover?

The Scheme does not cover, and will not provide compensation for:

any non-Serious Adverse Events; and
any adverse events (whether serious or non-serious) arising from a COVID-19 vaccine which: (a) has not 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).

In addition, the Scheme does not cover:

any Serious Adverse Events arising from a COVID-19 vaccine that is 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), if the vaccine in question is administered after more than two years from the date on which the vaccine in question was first marketed by the manufacturer in any country (see Schedule 1 (List of Vaccines) for this date); and
any Serious Adverse Events arising from a COVID-19 vaccine 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), for which a claim is submitted to the Administrator after the end of the Reporting Period, which is described in Question 9

Scheme

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.

Serious Adverse Event

UNICEF

An international inter-governmental organisation established by the General Assembly of the United Nations by resolution No. 57(1) of 11 December 1946 as a subsidiary organ of the United Nations.

Participating Country

Any country participating in the Scheme as listed in Schedule 9 of the Scheme’s Protocol (as may be updated from time to time).

Vaccine

A COVID-19 vaccine received in any Participating Country that is either: (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), that:

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

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.

Reporting Period

On a per Vaccine basis, the period during which a Claimant may file a Claim for compensation under the Scheme in respect of such Vaccine. The maximum Reporting Period for each Vaccine extends from:

the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.

For each Patient, the Reporting Period depends on the date the Vaccine was administered to the Patient. To calculate the Reporting Period that applies to the Patient, the Patient (or the person who is a duly authorised to represent the Patient as provided in limb (ii) of the definition of Claimant in the Scheme's Protocol) needs to:

determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.

3. Who administers the Scheme?

The Scheme is administered by the Scheme’s administrator, ESIS Inc. (the “Administrator”). ESIS is an independent claims administrator with over 30 years’ of relevant claims handling experience, and has secured regional centres around the world able to assist Claimants.

Scheme

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

Claimant

Any individual, who meets all of the following requirements:

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
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
the Vaccine was administered before its Scope of Coverage Endpoint (as indicated in Schedule 1 of the Scheme’s Protocol); and
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
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
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
has no pending lawsuits or claims for compensation for the Injury; and
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
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.

4. Do I need to pay any fees to the Administrator to download or submit a Claim or other forms under the Scheme?

No. The Administrator does not charge any fee for any individual to download or submit a Claim for compensation under the Scheme or for the submission of any other forms under the Scheme, including appeal forms.

You should exercise extreme caution in respect of any emails, text messages, telephone calls or other communications requesting you to make a payment as a condition for:

submitting a Claim under the Scheme, or
downloading or accessing a Claim Form or any other forms under the Scheme.

Do not make any such payment under any circumstances, as such emails, text messages, telephone calls or other communications are fraudulent and do not originate from the Administrator.

Administrator

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.

Scheme

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.

5. What is a Serious Adverse Event for which I can submit a Claim under the Scheme?

You can submit a Claim for compensation under the Scheme if you (or the person you represent) has suffered a “Serious Adverse Event”. This means a serious untoward medical occurrence that:

you (or the person you represent) has suffered or sustained following the administration of a COVID-19 Vaccine which 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);
and
results in an injury of the type described in Question 6 below.

Claim

Scheme

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.

Serious Adverse Event

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

UNICEF

An international inter-governmental organisation established by the General Assembly of the United Nations by resolution No. 57(1) of 11 December 1946 as a subsidiary organ of the United Nations.

Participating Country

Any country participating in the Scheme as listed in Schedule 9 of the Scheme’s Protocol (as may be updated from time to time).

6. What types of injuries are covered under the Scheme?

The Scheme covers serious bodily injury or illness that is suffered or sustained by a Patient and that:

requires Hospitalisation or prolongs an existing Hospitalisation; and
results in permanent total or partial Impairment; or
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
results in death.

Scheme

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.

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.

Hospitalisation

The admission of the Patient to a Hospital for more than 24 consecutive hours of resident overnight medical, surgical, and/or nursing care.

Impairment

A significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder, or disease.

The evaluation of an Impairment as provided in the Scheme's Protocol will be based upon the most recently published edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment (AMA’s Guides). Impairment percentages or ratings contained in the AMA’s Guides have been developed by medical specialists and are consensus-derived estimates that reflect the severity of the medical condition and the degree to which the Impairment decreases an individual’s ability to perform common activities of daily living.

The Impairment rating is a percentage that represents the extent of a whole person impairment of an individual, based on the organ or body function affected by an Injury (as defined in the Scheme's Protocol).

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

7. Where can I find more information about the Scheme?

You can find more information about the Scheme on this website (C19VaccineNFC.com).

If you have any questions about the Scheme which are not answered in these FAQs or by the information available on the Scheme’s website, you can contact the Administrator directly: (i) by email at [email protected]; (ii) by regular mail at one of the Scheme’s Regional Centres; or (iii) by calling the Scheme’s Global Telephone Hotline or the direct telephone numbers of the Scheme’s Regional Centres. Please see Question 20, below, for the Administrator’s regional mailing addresses and telephone numbers.

The most efficient way to contact the Administrator is either by email at [email protected] or through the “Contact Us” link on the Scheme’s website at C19VaccineNFC.com.

Scheme

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

B. About eligibility to apply for compensation under the Scheme.

8. Who can submit a Claim for compensation under the Scheme?

You can submit a Claim if you (or the person you represent) meet the following conditions:

You have been administered a COVID-19 Vaccine that was 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), and
Have suffered or sustained a Serious Adverse Event which:
- is associated with a COVID-19 Vaccine that has been either: (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), or with the administration of such a vaccine; and
- has resulted in an Injury of the types covered by the Scheme.

See Questions 5 and 6 above for more information about, respectively:

what is a Serious Adverse Event, and
what types of injuries are covered by the Scheme. See Question 10 below on how you can find out whether the COVID-19 Vaccine that was administered to you (or to the person you represent) 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).

Please note, however, that even if you (or the person you represent) meet the conditions above, this does not automatically mean that your Claim will be receivable under the Scheme or that, if your Claim is receivable, that you (or the person your represent) will be eligible to receive compensation under the Scheme. Indeed, a number of conditions need to be met:

in order for a claim for compensation to be receivable; and
if a claim is receivable, in order for you (or the person you represent) to be eligible for and receive such compensation.

These conditions are described in the Scheme’s Protocol.

Claim

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

UNICEF

An international inter-governmental organisation established by the General Assembly of the United Nations by resolution No. 57(1) of 11 December 1946 as a subsidiary organ of the United Nations.

Participating Country

Any country participating in the Scheme as listed in Schedule 9 of the Scheme’s Protocol (as may be updated from time to time).

Scheme

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.

Serious Adverse Event

Injury

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

requires Hospitalisation or prolongs an existing Hospitalisation; and
results in permanent total or partial Impairment; or
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
results in death.

9. How long do I have to apply for compensation under the Scheme?

You will have ample time to submit to the Administrator your Claim materials (i.e. the Claim Form, the Supporting Evidence Form, and all other documents required to be submitted with those forms).

You will need to submit your Claim materials before the end of the Reporting Period described below, in order for your Claim to be considered. You can find a drawing that illustrates the Reporting Period in Schedule 6 to the Scheme’s Protocol.

Provided that a COVID-19 vaccine either: (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), was administered to you (or to the person you represent) within the 2 years following the date on which that specific vaccine was first put on the market by the manufacturer in any country, then you will have an additional period of 36 months beyond the end of this 2-year period to submit a Claim for compensation under the Scheme.

To find out whether you received a COVID-19 vaccine that is covered by the Scheme, please read Question 10 below and see Schedule 1 (List of Vaccines) to the Scheme’s Protocol.

To find out on what date the Vaccine in question was first put on the market by the manufacturer, please see Schedule 1 (List of Vaccines) to the Scheme’s Protocol.

To calculate the Reporting Period that applies to you (or to the person you represent), please follow these steps:

Using Schedule 1 to the Scheme’s Protocol, you need to determine what is the End Point that applies to the Vaccine that was administered to you (or to the person you represent). This End Point is indicated in Schedule 1 to the Scheme’s Protocol, and is 24 months from the date that the vaccine in question was first put on the market by the manufacturer in any country; and
Calculate the number of months and days from the date that the UNICEF-distributed vaccine was administered to you (or to the person you represent) until the day of the applicable End Point, and add another 36 months. This establishes the Reporting Period that applies to you.

If you need help with calculating the Reporting Period that applies to you (or to the person you represent), please contact the Administrator so that someone can assist you (See Question 20 below for contact information).

You can apply for compensation under the Scheme within the Reporting Period described above, even if the Scheme-distributed Vaccine was administered to you (or to the person you represent) before the Scheme became fully operational. Please remember, however, that the 30-day waiting period described in Question 14 below will need to be observed before you or any Registered Healthcare Professional(s) take any steps towards completing the Claim Form or the Supporting Evidence Form that are to be submitted as part of the Claim materials.

Administrator

Claim

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

Reporting Period

the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.

determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.

Scheme

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.

UNICEF

An international inter-governmental organisation established by the General Assembly of the United Nations by resolution No. 57(1) of 11 December 1946 as a subsidiary organ of the United Nations.

Participating Country

Any country participating in the Scheme as listed in Schedule 9 of the Scheme’s Protocol (as may be updated from time to time).

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

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.

10. How do I know if I (or the person I represent) received a COVID-19 vaccine distributed by the COVID-19 Vaccine Facility No Fault Compensation Scheme?

To determine whether the COVID-19 vaccine that was administered to you (or to the person you represent) is covered by the Scheme, you will need to verify whether the vaccine is included in Schedule 1 of the Scheme’s Protocol (List of Vaccine). To verify this, you need to know: (1) the vaccine’s exact trade name; (2) the exact name of the vaccine’s manufacturer; and (3) the exact batch or lot number of the vaccine that was administered to you (or to the person you represent).

You may wish to refer to the vaccination card/record that was provided to you (or to the person you represent) to find this information, or ask the person or entity/organisation that administered the vaccine to you (or to the person you represent) to provide you with this information, so that you can compare it with the List of Vaccines in Schedule 1.

Scheme

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.

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

11. If I (or the person I represent) received a COVID-19 Vaccine that is not covered by the Scheme, can I apply for compensation under the Scheme?

No. If you (or the person you represent) received a COVID-19 vaccine that was not either: (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), then you cannot unfortunately apply for compensation under the Scheme. The reason for this is that the Scheme only covers Serious Adverse Events following the administration of a COVID-19 Vaccine which has been received through UNICEF or has formally been adopted by the Scheme.

UNICEF

An international inter-governmental organisation established by the General Assembly of the United Nations by resolution No. 57(1) of 11 December 1946 as a subsidiary organ of the United Nations.

Participating Country

Any country participating in the Scheme as listed in Schedule 9 of the Scheme’s Protocol (as may be updated from time to time).

Scheme

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.

Serious Adverse Event

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

12. How do I know if I am entitled to represent a person who has died, or is a child, or is incapacitated or otherwise lacks legal capacity to submit a Claim under the Scheme? What should I do to represent such a person?

To submit a Claim for compensation under the Scheme on behalf of a Patient who has died, or is a child, or is incapacitated or otherwise lacks the legal capacity to submit a Claim, you must fulfill all of the following requirements, which are found in Section 8(c) of the Claim Form (Schedule 2):

You must be the legally recognised parent, guardian, heir or legal representative (as applicable) of the Patient on whose behalf you are submitting a Claim; and
You must submit — together with (i.e., at the same time as) the Claim — a power of attorney or a statement that has been notarised by a Notary Official. The aforementioned notarised power of attorney or statement will need to:
- In all cases: Confirm that you are the legally recognised parent, guardian, heir or legal representative (as applicable) of the Patient on whose behalf you are submitting a Claim; and
- In the event the person has died: Additionally confirm that (A) you are the duly-authorised and legally recognised representative of all legal heirs of the Patient on whose behalf you are submitting a Claim (and the names of all such legal heirs must be listed in the power of attorney or statement); and (B) you have all necessary rights, powers and authority to represent, act for and bind all of such legal heirs; and (C) there are no other legal heirs of the Patient on whose behalf you are submitting a Claim, other than those legal heirs who are listed in the power of attorney or statement.

Claim

Scheme

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.

Patient

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.

C. About the Claims process

13. In what language(s) are the Scheme’s forms available and accepted? Can I complete and submit the Scheme’s forms and supporting documents in other languages?

The Scheme’s forms (together with accompanying instructions on how to complete and submit them) will be made available in English on the Scheme’s website (C19VaccineNFC.com).

You should complete and submit the Scheme’s forms in English in order for these forms and documents to be considered by the Administrator. Any Scheme forms that are completed or submitted in any other languages will be rejected and will not be considered.

However, any additional documents or information that are required or permitted to be provided with the Scheme’s forms, or are requested by the Administrator, can be submitted in another language, if they are not available in English.

Scheme

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

14. Is there a waiting period before I can submit a Claim under the Scheme? Why do I need to wait 30 days following the administration of a Scheme-distributed Vaccine before I can complete a Claim and/or ask a Registered Healthcare Professional to complete the Supporting Evidence form?

There is indeed a waiting period except in the case of death as provided in (ii) below. You must wait at least 30 days following the date on which the Vaccine was administered to you (or to the person you represent) before you and any Registered Healthcare Professional, as applicable, take any steps towards completing and submitting the Claim Form (Schedule 2) and the Supporting Evidence Form (Schedule 3).The reason for this 30-day waiting period is to allow Registered Health Professionals to determine whether the adverse event which you have suffered (or the person you represent, has suffered) is indeed serious. This avoids persons who suffer non-serious adverse events associated with a COVID-19 vaccine covered by the Scheme, or with the administration of such a vaccine, submit a Claim for compensation under the Scheme. Non-serious adverse events are not covered by the Scheme.
The 30-day waiting period does not apply in the case the person you represent has died following the administration of a COVID-19 vaccine covered by the Scheme, and the death is considered by a Registered Healthcare Professional to have been caused by this vaccine or its administration.

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

Registered Healthcare Professional

Claim

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

Scheme

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.

15. What forms and documents do I need to submit to apply for compensation under the Scheme? Do I need to submit all Claim materials at the same time?

To apply for compensation under the Scheme, you need to submit all Claim materials at the same time to the Administrator. The Claim materials consist of:

the Claim Form (Schedule 2) duly completed, signed and dated by you; and
the invoices, receipts or other proof of payment of any medical expenses (including Hospital fees) incurred as a consequence of the injury or illness suffered by the Patient for whom the Claim is being submitted; and
in the event the Patient has died, or is a child, or is incapacitated or otherwise lacks the legal capacity to submit a Claim, then you will also need to provide a power of attorney or statement (duly notarised) that meets the requirements set forth in Section 8(c) of the Claim Form (Schedule 2). Please see Question 12 above for more information about the requirements that apply to this power of attorney or notarised statement; and
the Supporting Evidence Form (Schedule 3) duly completed, signed and dated by one or more Registered Healthcare Professional(s); and
the documentation required to be submitted by the Registered Healthcare Professional(s) together with the Supporting Evidence Form (Schedule 3).

Scheme

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.

Claim

Administrator

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.

Patient

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

Registered Healthcare Professional

16. In what ways can I submit the Claim Form and other Scheme forms? Can I apply by phone?

Please note that you cannot complete or submit a Claim or any other Scheme forms by phone, and that the Administrator cannot complete or submit any Scheme forms for you.

All of the Scheme forms can be submitted to the Administrator through any of the following means:

Online, by uploading them to the Scheme’s website (C19VaccineNFC.com); and
By email, by emailing them to [email protected]; and
By regular mail, by sending them to one of the Scheme’s Regional Centres mailing addresses.

Claim

Scheme

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

17. What is the deadline to submit a Claim under the Scheme? What happens if I miss the deadline to submit a Claim?

If you (or the person you represent) received a COVID-19 Vaccine covered by the Scheme, then you must submit the complete Claim materials to the Administrator within the Reporting Period that applies to you (as described in Question 9 above). The complete Claim materials include the Claim Form, the Supporting Evidence form and all other documents required to be submitted with the Claim Form and Supporting Evidence form.

If you do not submit the complete Claim materials before end of the Reporting Period that applies to you (as described in Question 9 above), then you will unfortunately no longer be able to apply for compensation under the Scheme. If you submit a Claim Form or other Claim materials after the Reporting Period that applies to you, then your Claim will be rejected by the Administrator and cannot be considered.

Vaccine

either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
has not reached its Scope of Coverage Endpoint.

Scheme

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.

Claim

Administrator

Reporting Period

the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.

determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

18. Will I automatically receive compensation under the Scheme if: (a) I submit a Claim and Supporting Evidence, or (b) if I have been notified by the Administrator that my Claim and Supporting Evidence have been accepted as a Receivable Claim?

No. The submission of a Claim Form and Supporting Evidence Form to the Administrator does not automatically entitle you (or the person you represent) to receive a compensation payment under the Scheme. Similarly, the fact that the Administrator has notified you that your Claim has been accepted as a Receivable Claim under the Scheme does not, in and of itself, entitle you (or the person you represent) to receive payment of compensation under the Scheme.

The conditions for a Claim to be receivable, and the conditions for you (or the person your represent) to be eligible for and to receive compensation are described in the Scheme’s Protocol.

Claim

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

Administrator

Scheme

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.

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.

19. Who can have access to the information and documents that I submit in connection with a Claim?

The following persons may have access to, and examine, the personal, medical or other relevant information/records of you (or of the person for whom you are submitting the Claim):

The Administrator;
The members of the Review Panel;
The members of the Appeals Panel;
Any other persons representing and/or advising any of the persons mentioned above; and
Any other persons or entities mentioned in the ESIS, Inc. Privacy Policy for Covid-19 Vaccine Facility No-Fault Compensation Scheme.

In addition to the above, the personal and medical data of your (or of the person on whose behalf you are submitting a Claim) may be shared with any local health services and/or any local law enforcement or other government agencies, any intergovernmental organisations and any international institutions as may be required from time to time for the purposes of law enforcement, the detection of criminal activity, risk profiling of vaccines or any other reasonably proportionate activity which may from time to time be required in connection with your Claim or any appeals or other proceedings arising from or relating to it.

For more information, please refer to the ESIS, Inc. Privacy Policy for Covid-19 Vaccine Facility No-Fault Compensation Scheme.

Claim

Administrator

Review Panel

A panel appointed by the Administrator comprised of 5 duly licensed nurses, selected from a roster of 11 such nurses, who will review all Receivable Claims submitted by Claimants and determine – in accordance with the terms of the Scheme’s Protocol – whether Payment for compensation should be approved or denied.

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.

Scheme

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.

D. Questions on who to contact

20. Who do I contact if I have questions about the Scheme, a Claim or any Scheme forms, or if I need help with completing or submitting a Claim or other Scheme forms?

If you have questions about the Scheme, a Claim or any of the Scheme’s forms and these questions are not answered by these FAQ or other information available on the Scheme’s website, you can contact the Administrator by any of the following means:

By email, by writing to [email protected]; or
By regular mail, to one of the Scheme’s Regional Centres mailing addresses ; or
By telephone during regular business hours/days, either:
- By calling the Scheme’s Global Hotline at 00-1-404-905-8883.Please note that the telephone number for the Global Telephone Hotline may be toll-free or at-cost to the Claimant, depending on which country the Claimant is calling from. Claimants should verify whether or not any calling charges apply before calling the Global Telephone Hotline.
- Or by calling any of the (at-cost) direct telephone numbers of the Scheme’s Regional Centres as detailed at Contact Us by Phone.

The most efficient way to contact the Administrator is by email at [email protected] or through the “Contact Us” link on the Scheme website at C19VaccineNFC.com.

Scheme

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.

Claim

Administrator

Claimant

Any individual, who meets all of the following requirements:

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
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
the Vaccine was administered before its Scope of Coverage Endpoint (as indicated in Schedule 1 of the Scheme’s Protocol); and
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
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
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
has no pending lawsuits or claims for compensation for the Injury; and
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
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.

21. Who should I contact for the required Supporting Evidence?

You should contact the Registered Health Professional(s) who has (have) treated you (or the person you represent) for the injury or illness associated with the COVID-19 vaccine covered by the Scheme, so that they can: (i) complete and sign the Supporting Evidence Form (Schedule 3) that is required to be submitted with your Claim; and (ii) provide you with the other supporting documents that are required to be attached to the Supporting Evidence Form. You should not complete or sign the Supporting Evidence Form yourself; if you do so, then the form will not be accepted or considered by the Administrator.

Registered Healthcare Professional

Scheme

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.

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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

Administrator

22. How can I find a notary public or other public official legally authorised to provide notarisation and/or legalisation services within the country in which I reside?

We suggest that contact your local government authorities to obtain this information.

E. About the process after a Claim has been submitted

23. What happens after I submit a Claim Form and other Claim materials under the Scheme?

After all Claim materials (i.e., the Claim Form, the Supporting Evidence Form and the other documents required to be submitted with those forms) have been duly completed, signed, dated and submitted to the Administrator, the following steps (among others) will follow:

You will receive an written acknowledgement from the Administrator that your Claim materials have been received, and one of the Administrator’s examiners will contact you via email or regular mail; and
Your Claim materials will be reviewed by the Administrator within 7 days of their date of receipt to determine (in accordance with the terms of the Scheme’s Protocol) whether:
- the Claim Form is: (a) duly complete, signed and dated, and (b) accompanied by the required Supporting Evidence Form (also duly complete, signed and dated) and by the other documents required to be submitted together with the Claim Form and the Supporting Evidence Forms;
- the complete Claim materials have been submitted before the end of the Reporting Period, which is illustrated in Schedule 6 to the Protocol (also see Question 9 above);
- you (or the person on whose behalf you are submitting the Claim) meet all the requirements of a Claimant under the Scheme; and
- the Claim constitutes a Receivable Claim under the Scheme.
If your Claim is found by the Administrator to be incomplete, then the Administrator will invite you to submit the missing documents, and you will have a period of 90 days from the date of the Administrator’s notification to submit these missing documents to the Administrator.
If your Claim is found by the Administrator to be a Receivable Claim under the Scheme, then the Administrator will:
- submit all of your Claim materials to the Scheme’s Review Panel as soon as possible (and no later than 7 days) after the Administrator’s above mentioned finding; and
- send you a written notice that your Claim has been accepted as a Receivable Claim under the Scheme. Please note that the acceptance of a Claim as a Receivable Claim under the Scheme does not, in and of itself, entitle you (or the person you represent) to the payment of compensation under the Scheme; see Question 18 above, for more information. Your Claim will still need to be assessed by the Review Panel, which will determine (in accordance with the relevant provisions of the Protocol) whether or not your Claim can be approved for compensation under the Scheme.
If your Claim is found by the Administrator to not be a Receivable Claim under the Scheme, then:
- your Claim will be rejected, and
- the Administrator will send you written notice that your Claim has been rejected because it does not constitute a Receivable Claim under the Scheme. The Administrator’s notice will include:
  - the grounds for the rejection of your Claim,
  - a notification of your right to appeal this decision, and
  - a copy of the Notice of Appeal of Rejected Claim Form (Schedule 4) that you need to timely and duly complete and submit, if you wish to appeal this decision. Please see Question 27 and Question 29, below, for more information about filing an appeal to a rejected Claim using the Notice of Appeal of Rejected Claim Form.

Claim

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

Administrator

Reporting Period

the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.

determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.

Claimant

Any individual, who meets all of the following requirements:

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
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
the Vaccine was administered before its Scope of Coverage Endpoint (as indicated in Schedule 1 of the Scheme’s Protocol); and
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
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
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
has no pending lawsuits or claims for compensation for the Injury; and
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
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.

Scheme

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.

Receivable Claim

Review Panel

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.

24. What happens if I miss a deadline under the Scheme, after I have submitted a timely Claim?

If you have submitted a timely Claim, but thereafter fail to meet any relevant deadlines prescribed by the Scheme’s Protocol, then the Administrator may deny and close the process in respect of your Claim (including any pending reviews and/or appeals). To avoid this, you should:

always carefully verify what deadlines apply, and
submit all required documents and information to the Administrator in a timely manner (and take timely steps to ensure that you can meet these deadlines).

Any deadlines that apply after you have submitted a timely Claim, are generally 90 days from the date of the Administrator’s notification to you. This should give you ample time to comply.

Claim

Administrator

25. Can I modify a Claim after it has been submitted?

If you wish to modify your Claim Form, Supporting Evidence Form or any other Claim materials after they have been submitted to the Administrator, then you will need to:

First, withdraw your existing Claim. Please see Question 26 below for more information about how to withdraw a Claim after it has been submitted; and
Then, complete (or have completed) and submit to the Administrator a new/modified set of Claim materials (meaning new Claim Form, Supporting Evidence Form and all other documents required to be provided under the terms of these forms). Please note that you will need to resubmit all Claim materials together with and at the same time as the new/modified Claim, even if only some (but not all) of the Claim materials have been modified.

Please make sure that your new/modified Claim Form, Supporting Evidence Form and other Claim materials are submitted to the Administrator before the end of the Reporting Period that applies to you. If your new/modified Claim materials are submitted after the end of this period, then your Claim cannot be accepted and will be rejected. Please see Question 9 above for more information about how to calculate the Reporting Period that applies to you.

Claim

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

Administrator

Reporting Period

the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.

determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.

26. Can I withdraw a Claim after it has been submitted?

Yes, you can withdraw your Claim:

at any time before you have accepted the Administrator’s approval of Payment in respect of your Claim (that is, before you have submitted to the Administrator the signed and certified Release Agreement referred to under Question 31 below); and
for any reason, including if you want to modify your Claim (see Question 25 above).

To withdraw a Claim, please send an email or regular mail to the Administrator, in which you include the following: (1) the Claimant’s name; (2) the Claim number; and (3) a statement that you want to withdraw your Claim for compensation under the Scheme, including the reasons why.

Please note that after you withdraw your Claim: (a) you will not be permitted to reinstate or reopen the withdrawn Claim, and (b) if you wish to later re-apply for compensation under the Scheme, you will need to complete (or have completed), obtain and submit to the Administrator a whole new Claim Form, Supporting Evidence Form and all other documents required to be provided under the terms of these forms, before the end of the Reporting Period that applies to you. Please see Question 9 above for more information about how to calculate the Reporting Period that applies to you.

Claim

Administrator

Payment

The no fault, lump-sum payment which in respect of a Receivable Claim (i) has been approved by the Review Panel or the Appeals Panel, as applicable, (ii) is calculated utilising the mechanism detailed in Section 9 of the Scheme's Protocol, and (iii) is to be paid (subject to and in accordance with the conditions set forth in the Scheme's Protocol and its Schedules) to a Claimant in full and final settlement and compensation of all claims arising from or relating to the Injury.

Claimant

Any individual, who meets all of the following requirements:

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
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
the Vaccine was administered before its Scope of Coverage Endpoint (as indicated in Schedule 1 of the Scheme’s Protocol); and
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
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
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
has no pending lawsuits or claims for compensation for the Injury; and
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
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.

Scheme

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.

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

Reporting Period

the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.

determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.

27. My Claim has been rejected on the grounds that it is not a Receivable Claim under the Scheme. What can I do if I disagree?

If your Claim has been rejected by the Administrator on the grounds that it does not constitute a Receivable Claim under the Scheme, and you disagree with this decision, then you can file an appeal by following the procedure described in Section 7 of the Scheme Protocol.

To appeal the rejection of a Claim in this context, you must complete, sign and submit to the Administrator the form entitled “Notice of Appeal of Rejected Claim” (Schedule 4). Please bear in mind that you will not be permitted to provide any new or additional documents in connection with your appeal in this context.

You must submit the Notice of Appeal of Rejected Claim Form to the Administrator no later than 90 days after the date of the Administrator notification that your Claim was rejected because it does not constitute a receivable claim under the Scheme.

Please see Section 7 of the Scheme Protocol for more information about the appeals process that applies when a Claim is rejected on the grounds that it does not constitute a Receivable Claim under the Scheme. Please also see Question 29 for more information about what happens after you submit a Notice of Appeal of Rejected Claim Form.

IMPORTANT NOTE: if your Claim does constitute a Receivable Claim, but was denied compensation under the Scheme, and you disagree, please do not use the appeals procedure outlined above and refer to Question 28 instead.

Claim

Administrator

Receivable Claim

Scheme

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.

Notice of Appeal of Rejected Claim (denial of receivability)

28. My Claim has been denied compensation under the Scheme. What can I do if I disagree?

If your Claim constitutes a Receivable Claim but has been denied compensation under the Scheme, and you disagree with this decision, then you can file an appeal by following the procedure described in Section 8 of the Scheme Protocol.

To appeal the denial of compensation in this context, you must complete, sign and submit to the Administrator the form entitled “Notice of Appeal of Denied Receivable Claim” (Schedule 5). If there are any additional documents that you wish to provide in support of your appeal of a denied Receivable Claim, then you must submit these additional documents at the same time as you submit your Notice of Appeal of Denied Receivable Claim Form to the Administrator.

You must submit the Notice of Appeal of Denied Receivable Claim Form (together with any additional documents you wish to provide in support of the appeal) to the Administrator no later than 90 days after the date of the Administrator’s notification that your Claim/Receivable Claim was denied compensation under the Scheme.

Please see Section 8 of the Scheme’s Protocol for more information about the appeals process that applies when a Claim/Receivable Claim is denied compensation under the Scheme. Please also see Question 30 below for more information about what happens after you submit a Notice of Appeal of Denied Receivable Claim Form.

IMPORTANT NOTE: If your Claim was rejected on the grounds that it does not constitute a Receivable Claim under the Scheme, and you disagree, then please do not use the appeals procedure outlined above and refer to Question 27 instead.

Claim

Receivable Claim

Scheme

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

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.

29. What happens after I submit a Notice of Appeal of Rejected Claim?

After the Administrator receives your duly completed, signed, and dated Notice of Appeal of Rejected Claim (and provided that your Notice was submitted before the applicable deadline) then the following process will apply:

Within 7 days of receipt, the Administrator will provide your Notice of Appeal of Rejected Claim Form, together with the other appeals materials(*), to the Administrator’s Vice President of Risk Consulting.
Within 30 days of receipt, the Administrator’s Vice President of Risk Consulting will: review your Notice of Appeal of Rejected Claim and the other appeals materials(*), and on this basis, make a determination whether to confirm or reverse the prior rejection of your Claim.
The Administrator’s Vice President of Risk Consulting will communicate his determination to confirm or reverse the prior rejection of your Claim (including the grounds for his determination) in writing to the Administrator, no later than 7 days after making that determination.
The Administrator will send you written notice of the determination to confirm or reverse the prior rejection of your Claim (including the grounds for that determination), no later than 14 days after the Administrator’s Vice President of Risk Consulting has communicated that determination to the Administrator.
The decision/determination of the Administrator’s Vice President of Risk Consulting concerning your Notice of Appeal of Rejected Claim is final and cannot be appealed.

(*) For purposes of this question only, the “appeals materials” means: (1) your Notice of Appeal of Rejected Claim; (2) your original Claim Form and Supporting Evidence form (together with any documents that may be required pursuant to their terms); and (3) any additional information and/or documents that may have been requested by the Administrator and that were submitted by you in a timely manner.

Administrator

Notice of Appeal of Rejected Claim (denial of receivability)

Claim

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

30. What happens after I submit a Notice of Appeal of Denied Receivable Claim?

After the Administrator receives your duly completed, signed, and dated Notice of Appeal of Denied Receivable Claim (and provided that your Notice was submitted before the applicable deadline) then the following process will apply:

Within 7 days of receipt, the Administrator will provide your Notice of Appeal of Denied Receivable Claim Form, together with the other appeals materials (*), to the Scheme’s Appeals Panel.
Within 30 days of receipt, the Appeals Panel will: review your Notice of Appeal of Denied Receivable Claim Form and the other appeals materials(*), and on this basis, make a determination whether to confirm or reverse the prior denial of compensation under the Scheme in respect of your Receivable Claim.
The Appeals Panel will communicate its determination to confirm or reverse the prior denial of compensation under the Scheme (including the grounds for its determination) in writing to the Administrator, no later than 7 days after making its determination.
The Administrator will send you a written notice of the Appeal Panel’s determination to confirm or reverse the prior denial of compensation (including the grounds for that determination), but no later than 14 days after the Appeals Panel has communicated that determination to the Administrator.
The decision of the Appeals Panel concerning your Notice of Appeal of Denied Receivable Claim is final and cannot be appealed.

(*) For purposes of this question only, the “appeals materials” means: (1) your Notice of Appeal of Denied Receivable Claim (together with any documents that may be required by and/or have been submitted with this Notice of Appeal); (2) your original Claim Form and Supporting Evidence form (together with any documents that were submitted with those forms); and (3) any additional information or documents that may have been requested by the Administrator and that were submitted in a timely manner to the Administrator.

Administrator

Notice of Appeal of Denied Receivable Claim

Scheme

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.

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.

Receivable Claim

Claim

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:

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;
a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
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;
certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
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
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.

31. My Claim has been approved for payment by the Administrator. What should I do to receive this payment?

Once you have been notified by the Administrator that your Claim has been approved for Payment, you will need to:

Sign and date the Release Agreement, which the Administrator will send to you with the notification that your Claim has been approved for Payment, and have this Release Agreement certified by a Notary Official;
Complete and sign the Payment Method Election form, which the Administrator will send to you with the notification that your Claim has been approved for Payment; and
Return the signed, dated and certified Release Agreement and the completed Payment Method Election form to the Administrator within 90 days from the date of the Administrator’s notice that your Claim has been approved for Payment.

The Release Agreement is described in Section 11 of the Scheme’s Protocol and the Payment Method Election form is described in Section 2 of the Scheme’s Protocol.

Through the Release Agreement, you agree that the Payment is not an admission of fault, wrongdoing, responsibility or liability on the part of any person or entity listed in Section 11(a) of the Scheme’s Protocol. The reason for this is that Scheme does not address and does not provide any determination of fault on the part of any such person or entity. The Scheme is a no fault compensation scheme.

Through the Release Agreement, you furthermore agree that the Payment is in full and final consideration of the Injury in question, and in full and final settlement of any claims which you (or the person you represent) may have against the parties mentioned in Section 11(a) of the Scheme Protocol.

To this end, you release them from such actions and waive the right to seek and/or obtain compensation in respect of the Injury in question from any other public source, including from any governmental or publically funded no-fault compensation scheme. This is to avoid situations where an individual seeks to obtain compensation from multiple sources for the same injury.

Provided that you have returned the signed, dated and certified Release Agreement and the completed Payment Method Election form to the Administrator within 90 days from the date of the Administrator’s notice, the Administrator will proceed to make the Payment, within 28 days of the Administrator’s receipt of these documents.

Subject to any restrictions imposed by applicable laws and regulations, the Administrator will effect Payment through the payment method you have elected.

Please note however that if you do not collect or cash the Payment within six (6) months after the issuance of this Payment, the Administrator will credit the funds back to the Scheme in the amount of the uncollected and/or uncashed Payment, and you will lose your entitlement.

Administrator

Claim

Payment

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.

Scheme

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.

Injury

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

requires Hospitalisation or prolongs an existing Hospitalisation; and
results in permanent total or partial Impairment; or
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
results in death.