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TRANSPLANTATION OF HUMAN ORGANS

FORM 9

[Refer rule 4(3) (a) (b)]

 

I, Shri/Smt. .............. s / o. w / o, Shri ................ resident of ........... hereby authorize removal of the organ / organs, namely, ......... for therapeutic purpose from the dead body of my son / daughter Shri / Km. ...........aged ............. Whose brain-stem death has been duly certified in accordance with the law.

 

Signature........................

Name.................

Date................

Place....................

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