I................................... s/o,d/o,w/o .......................
aged ...................resident of. ..............................
having lawful possession of the dead body Sri/Smt/km .....................s/o,d/o,w/o ..................................
aged........... of..................................................... having known that the deceased has not expressed any objection to his/her organ/organs being removed for therapeutic purposes after his/her death and also having reasons to believe that no near relative of the said deceased person has objection to any of his/her organs
being used for therapeutic purposes authorise removal of his/her body organs,
Signature.....................
name. .......................
Dated..........................
Place …………………. .........
Person in lawful possession of the dead body
Address..................................................................
..............................................................................
|
FORM -7
[(See rule 4(2) (b)]
|
I,Mr/Mrs./Miss....................................................having lawful possession of the deadbody of Mr/ Mrs./Miss ....................................................son of/ daughter of / wife of ..................... ............ aged ........................... resident of ........................................after having known that the objection was expressed by the deccased to any of his human organs being used after is death for therapeutic purposes and having reason to believe of deccased person has objection to any of the deccased person's organs being used for therapeutic purposes, hereby authorise the removal of the deceased’s organ, namely, ………………………………………………. for therapeutic purposes. Signature........................................................
Name..............................................................
Address..........................................................
.......................................................................
Time and Date ……………………………...
|
