Aug 22 2014

BODY DONATION FORM

IMAMaharashtraState.org @ 6:27 am

BODY DONATION FORM_1

BODY DONATION FORM

BODY DONATION FORM

FROM:

_________________________________________

 

_________________________________________

 

Tel. No.: _________________________________

 

To,

 

The Professor  & Head,

Department of Anatomy, Grant Medical College ,

J. J. Group Hospital, Mumbai – 400 008.

Phone Nos.: 022-2376 9400 / 0943 / 2373 5555

 

OR

 

Lokmanya Tilak Municipal Medical Collage,

Sion Hospital, Sion, Mumbai – 400 022.

Phone Nos.:022-2407 6381 / 6382/2409 5099

 

OR ANY LOCAL MEDICAL COLLEGE /HOSPITAL

 

Date :

 

Dear Doctor,

 

I desire to donate my entire body after my death for study and other uses.

 

Kindly accept the same.

 

Thanking you,

 

Yours faithfully,

 

________________

 

Signature

 

No objection from close relatives

 

We have no objection to donate the Body of Shri. / Ms. __________________________________

 

age _______________ after his / her death, for educational and other purpose to Anatomy

 

Department, grant Medical College & Sir J. J. Group of Hospital & Sion Hospital.

 

 

Tel No.                            Name                            Relation

Signature

 

N.B. : – Close Relation – Father, Mother, Husband, Wife, Son, Daughter, Brother, Sister etc.

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