The Transplantation of Human Organs Rules, 1995 - Form 2

FORM - 2
[(See rule 4(1) (b)] 

I, Dr.…………………………………………........, possessing the qualification of  ........…………… registered as medical practitioner at serial No. ................. by the ....................................... Medical as Medical Council, certify that I have examined Shri / Smt / Kum. ............................. S/o, D/o, W/o ......................................................... aged ................................ who is free and is near relative of the donor and that the said donor is in proper state of health and is ........................... medically fit to be subjected to the procedure of organ removal. 

Place: ..........................