IMA Mumbai West Indian Medical Association – Mumbai West ,IMA BUILDING,JUHU, J R MHATRE MARG, MUMBAI 400049

March 28, 2012

Body Donation form

Filed under: — IMAMW @ 10:33 pm

BODY DONATION FORM

 FROM:

_________________________________________

_________________________________________

Tel. No.: _________________________________

 

To,

 

The Professor & Head,

Department of Anatomy,

Grant Medical College ,

J. J. Group Hospital,

Mumbai – 400 008.

Phone Nos.: 022-2376 9400 / 0943 / 2373 5555

OR

Lokmanya Tilak Municipal Medical Collage,

Sion Hospital,

Sion, Mumbai – 400 022.

Phone Nos.:022-2407 6381 / 6382/2409 5099

Date :

 

Dear Doctor,

 

I desire to donate my entire body after my death for study and other uses.

 

Kindly accept the same.

 

Thanking you,

 

Yours faithfully,

 

 

________________

Signature

 

No objection from close relatives

 

We have no objection to donate the Body of Shri. / Ms. _________________________________________ age ________________ after his / her death, for educational and other purpose to Anatomy Department, grant Medical College & Sir J. J. Group of Hospital & Sion Hospital.

 

No.

Name

Relation

Signature

1

     

2

     

3

     

 

N.B. : – Close Relation – Father, Mother, Husband, Wife, Son, Daughter, Brother, Sister etc.

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