Fill the form below for Organ Donation

Hereby Authorize the removal of my following organ/organs from my body after my death for therapeutic purpose.

In case of emergency

Contact 1:

Contact 2:

Pledge card will be issued on the basis of information provided above.

The final consent of family will be required before retrieving the organs even if the donor has filled a donar card.

Kutch Yuvak Sangh

1, First Floor, Takshashila co-op housing society, Gokuldas Madhavdas Pasta Road, Behind Chitra Cinema, Dadar (East), Mumbai, Maharashtra, 400014
Tel.: 022 - 2411 4001 / 2411 4002 | Email: