Covid19-Test Full Name * Email * Amount (NGN) * Last Name * First Name * Phone Number * Date of Birth * Gender MaleFemale" Email Addrress * State * AbiaAdamawaAkwa IbomAnambraBauchiBayelsaBenueBornoCross RiverDeltaEbonyiEdoEkitiEnuguFCTGombeImoJigawaKadunaKanoKatsinaKebbiKogiKwaraLagosNasarawaNigerOgunOndoOsunOyoPlateauRiversSokotoTarabaYobeZamfara" * are compulsory ResetPay