Name: _______________________________________________________________________

Contacts: _____________________________________________________________________

Facility: ______________________________________________________________________

Department: __________________________________________________________________

Dear Sirs,


The above matter refers.

I take note of the College’s exercise to issue the COVID-19 vaccination. 

Please note that I am seeking a religious exemption against the said vaccination. I hold sincere religious beliefs which are contrary to the practice of vaccination and fully aware that the law affords me a right to refuse the vaccine based on this sincere religious belief.

Kindly note that I am ready to subject myself to any procedures that you may require for such exemption including but not limited to producing evidence to support my assertions.

Thank you in advance.

Yours sincerely,


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