"*" indicates required fields PANBIO™ COVID-19 ANTIGEN SELF-TEST - Kit RegistrationProduct Code: 41FK51, 41FK71, 41FK81, 41FK91 Lot Number: TBA Conditional Approval Reference Number: TBAPurchaser Full Name*Phone Number*Email address* Premise where the purchase was made*Date of Purchase* MM slash DD slash YYYY Time of Purchase* Hours : Minutes AM PM AM/PM Quantity of Tests Purchased*By providing us with your personal information, you hereby accept and agree to Abbott’s Privacy Policy. Specifically, you provide your clear consent for Abbott’s collection, use and/or processing of any of your personal information provided hereunder, and for Abbott to disclose and transfer your personal information to relevant governmental authorities including but not limited to the Ministry of Health and Medical Devices Authority. Please note that the submission of any false or incorrect personal information may be subjected to fines and/or other penalties by the governmental authorities.* I have read and understood Abbott’s Privacy Policy and hereby provide my consent for the above CAPTCHACommentsThis field is for validation purposes and should be left unchanged.