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....................