FORM 9
[Refer rule 4(3) (a) (b)]
I, Shri/Smt. .............. s / o. w / o, Shri ................ resident of ........... hereby authorize removal of the organ / organs, namely, ......... for therapeutic purpose from the dead body of my son / daughter Shri / Km. ...........aged ............. Whose brain-stem death has been duly certified in accordance with the law.
Signature........................
Name.................
Date................
Place....................
Place: Hyderabad
Date:22.08.2014
J Place: Chennai
Date:28.11.2013
Place: Chennai
Date:31.08.2013
Place: Hyderabad
Date:07.04.2013
Place: Bengaluru
Date:04.12.2012
Place: Hyderabad
Date:26.10.2012