Result Reporting to Geomico - Start here
Date Of Birth *
Gender * MALEFEMALE
Your name *
ID Type * NRICPASSPORT
ID *
Your email *
Residental Address *
Phone Number *
Verify Code *
Medical Device * BHM COVID-19 RTK NASAL CASSETTE - CA REF (71) MDA.600-1/6/27 - LOT NO G2108003BHM®️ COVID-19 RTK SALIVA CASSETTE_SELF TEST /CA ref/ 21GIMS001BHM®️ COVID-19 RTK NASAL/ORAL STRIP_SELF TEST /CA ref/ 21GIMT001
the premise where the purchase is made *
Date of purchase *
Time of purchase (in HH:MM XM format) *
*compulsory to fill in