The Transplantation of Human Organs Rules, 1995 - Form 6

FORM -6
[(See rule 4(2) (b)] 

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, namely..............................................

Dated...............................                                                                                              

Place …………………...  Person in lawful possession of the dead body 

Address..................................................................................
...............................................................................................