dc66e42ec4
Categories now match folder names (15 canonical values). Types normalized to 25 canonical values per VAULT_MAP.md spec. Context-aware mapping: W-2s→tax-form, lease files→lease, vet records→vet, etc.
49 lines
2.1 KiB
Markdown
49 lines
2.1 KiB
Markdown
---
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type: vaccine
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category: travel
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person: Yanxin Lu
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date: 2021-12-16
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source: 疫苗接种声明书_lu.pdf
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---
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# 新冠疫苗接种声明书 / Letter of Commitment on COVID-19 Vaccination — Lu Yanxin
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## Declarant Information
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| Field (中文) | Field (English) | Value |
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|------------|-----------------|-------|
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| 声明人姓名 | Name | 陆彦忻 |
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| 性别 | Gender | 男 (Male) |
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| 出生日期 | Date of Birth | 1989年10月17日 |
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| 护照号 | Passport No. | E93603635 |
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| 电话 | Telephone | +12542241457 |
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| 电邮 | Email | crac1017@gmail.com |
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## Statement (声明内容)
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1. 本人已接种新冠疫苗，接种详情如下 / I have received COVID-19 vaccination and the details are as follows:
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| # | Field (中文) | Field (English) | Value |
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|---|-----------|-----------------|-------|
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| 1 | 疫苗品牌名称 | Vaccine brand name | 辉瑞 (Pfizer) |
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| 2 | 接种机构名称 | Name of vaccination institution | Forum Stadium |
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| 3 | 接种机构地址 | Address of vaccination institution | 3900 W Manchester Blvd, Inglewood, CA, 90305 |
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| 4 | 接种机构联系方式 | Contact information | 833-540-0473 |
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| 5 | 疫苗接种剂次 | Doses | 二剂次 / Two doses (checked) |
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### Vaccination Dates
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| Dose | Date |
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|------|------|
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| 第一剂 / First dose | 2021年4月15日 |
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| 第二剂 / Second dose | 2021年5月6日 |
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2. 本人所附疫苗接种凭证（接种卡或其它接种证明）真实无误。
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I hereby declare that the attached vaccination certificate (vaccination card or other forms of certification) is true and accurate.
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本人保证以上所有内容真实，并愿意承担由此引起的一切法律责任，包括但不限于因虚报、瞒报导致被限制去中国旅行或被追究法律责任等后果。
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I hereby declare that the information provided above is true, and I shall bear all legal responsibilities arising therefrom, including but not limited to restricted travel to China, punishment by law, or other consequences in the case of partial or false disclosures.
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**声明人签名 / Signature:** (signed)
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**日期 / Date:** 2021年12月16日
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