Please tick as applicable:

Heart Lungs Kidneys
Liver Pancreas

(Following tissues can also be donated after brain stem deathas well as cardiac death)

Corneas/Eye Balls Skin Bones
Heart Valves Blood Vessels
Upload Signature (200 KB) Upload ID (<1 MB)
(Note: In case of online registration of pledge, one copy of the pledge will be retained by pledger,
one by the institution where pledge is made and a hard copy signed by pledger and two witnesses shall be sent to
the nodal networking organisation.)
(Details of Witness 1)
(Details of Witness 2)