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The Transplantation of Human Rules - 1995 - new

 

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 .




Place

Date .








To be self attested across the affixed photograph

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