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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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