Fillable Printable Generic Eye Donation Form

Generic Eye Donation Form

EYE DONATION FORM

Please fill up the space and give it to your next of kin. You can also give a copy to the nearest

eye bank.

Full Name & Full Address:

Telephone Number

TO WHOMSOEVER IT MAY CONCERN

In the hope that I may help others, I hereby make this gift to be effective upon my death.

I declare my desire for eye donation after my death. Hence I sincerely request my close

relatives, friends and well wishers to

contact and call the nearest available eye bank in the

event of my death, as quickly as possible.

Signature

Name:

Place:

Date:

Important Eye banks in Delhi:

Guru Nanak Eye Centre

23234612

National Eye Bank (AIIMS)

22651123;26864851

AIIMS(Eme

rgency)

26569461

Rotary Delhi Centre Eye Bank, Sir Ganga Ram Hospital

25781837, 25721800

Apollo Eye Bank

26925858

A-

Edward Maumenee

Eye Bank(A Unit of Venu charitable Society)

26291951