i WILL to Touch Lives
Pledge Form for Organs, Skin & Eye Donation - an Initiative of Rotary Club of Bombay West
I hereby unequivocally authorize the removal of my ORGANS (only after I am declared brain stem dead), AND/OR my SKIN & my EYES from my body for therapeutic purposes after my death (caused due to any reason)
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My Father's / Husband's Name
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My Age (in completed years)
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My Residential Address
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City
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Pincode
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My Email ID
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My Phone No.
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My Blood Group Is
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