BECOME AN ORGAN DONOR

BECOME AN ORGAN DONOR

AN INITIATIVE FOR ORGAN DONATION

Registration Number
Passport size photo
First name
Last name
Email Id
Aged
Date Of Birth
Whatsapp No.
Gender

Organ(s):

Tissues(s):

My Blood Group is (if Known)
Telephone No.
Email Id.
Address for correspondence*

Name of Relative ( Next kin )

First name
Last name
Email Id
Aged
Whatsapp No.
Gender
Address*
Your Relation with applicant*

Note:

Organ Donation is a family decision. So it is important that you discuss your decision with family members and loved ones so that it will be easier for them to follow through with your wishes. The person making the pledge has the option to withdraw the pledge. After filling the form, Kindly send it to Donate Life, on address mention below.