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Donor Card Registration

 

 Personal Details:
Name : Surname :
Father's Name Date of Birth :
                Sex Occupation :
Email Address: Confirm Email :
Mobile Number(self): BloodGroup :
Relative Name: Mobile Number(relative):
Address : City:
Pincode :
 Your Wishes:
I am willing to donate organs in case of brain death:
 
        

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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