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........... resident 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,
Signature.....................
name. .......................
Dated..........................
Place …………………. .........
Person in lawful possession of the dead body
Address..................................................................
..............................................................................