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Medical Termination of Pregnancy Rules, 2003

FORM C - Form of consent
( See rule 8 )
 
 I ___daughter/wife of ____aged about ____years of  ___( here state the permanent address) at present  residing at  ____ do  hereby  give  my  consent  to  the   termination  of  my  pregnancy  at ____
(State the name of place where the pregnancy is to be terminated)
 
Place    :
 
Date     :                                                                  
 
                                          Signature
 
 ( To be filled in by guardian where the woman is a mentally ill person or minor )
 
 I___son/daughter/wife of ___aged about ___years of ____at present residing at ( Permanent address ) ____
 
do hereby give my consent to the termination of the  pregnancy of my ward ____
 
who is a minor/lunatic at ____
 
(place of termination of my pregnancy)
 
Place:
 
Date:      
                     Signature

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