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Donor Form

 
*   Myself
 
* Name  
 
* Full Address
I declare that, after my death my body be donated for the purpose of study and / or research work by Dept. of Anatomy medical college, Raipur, Dept. of Anatomy medical college, Raipur lawfully in-charge of my body after my death and nobody neither my relative not my nominees has rights to make any objection on it.

*

Relative Name  
 
  Relation
 
* Donor Signature
 
* Name & Address
 
 
* Relative Signature
 
* Name & Address
Witness :-
* Name * Address * Signature
 
* Name * Address * Signature