THE TRANSPLANTATION OF HUMAN ORGANS ACT, 1994
(Central Act 42 0f 1994)

FORM 9
             (See rule 4(3) (b))                

 

I, Mr/Mrs....................................son of / wife of.......................resident of...........................
hereby authorise removal of the organ/organs namely..................................for therapeutic
purposes from the dead body of my son/daughter .
 Mr/Ms...............................................................aged.........................whose brain stem
death has been duly certified in accordance with the law
                                                                                                Signature..............................

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

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

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

      FORM -10  

 APLICATION FOR APPROVAL  FOR TRANSPLANTATION LIVE DONOR OTHER THAN  NEAR RELATIVE
   Whereas I ....................................................S/O, D/O, W/O, L/O.............................aged
residing...................................................................have been informed by my doctor that I am suffering from.......................and may be benefitted by transplantation ......................... into my body.
 and whereas I ......................................................…………………………….. S.O. D.O. W.O......................................... aged .................. residing at..........................................by reason of affection and attachment because :
..............................................................................................................................................
..............................................................................................................................................
  (reason to be filled in) would like to donate my....................................to............................we.................................

                                                                                                                      (donor)
and............................................hereby apply to authorisation committee for permission      (Recipient) for such transplantation to be carried out.
  We solemnly affirm that the above decision has been taken without any undue pressure, inducement, influence or allurement and that all-possible consequences and options of organ transplantation have been explained to us.
............................................................................................................................................
............................................................................................................................................
 

  Signature and address of prospective                   Signature and address of prospective   

  donor                                                                     recipient