Akhil Bharatiya Terapanth Yuvak Parishad

registration form

Eye Donation

Member of Eye Bank Association of India

DONAR’S PLEDGE

Faq
  • I give my eyes for the purpose of Transplantation, medical research or education
  • I further direct my next-of-kin herein named to execute this gift after my death.
  • I would like my next-of-kin notified of my pledge to donate

BASIC DETAILS

Select State

City

DONAR’S DETAILS

Name

Gender

Mobile No.

Email Id (Optional)

Address.

DOB

Blood Group

Are you interested for Blood Donation

WITNESS DETAILS

1.Name

Mobile No.

Relation

2.Name

Mobile No.

Relation

instruction

  • 1.If you are not 18years, have your Guardian or Parent confirmed as one of your witness.
  • 2.Discuss your decision with your next-of-kin and your family doctor.
  • 3.We will send you in return a wallet card stating your pledge and instructing your next-of-kin desires.
  • 4.Pls carry the wallet card with you at all time. If you change your Name or mobile Number or Address, pls inform Akhil Bhartiya Terapanth Yuvak Parishad.

Sandeep Kothari

President

Navneet Mutha - 8904040547

National Convenor

Manish Daftari

General Secretary