The Transplantation of Human Organs Rules, 1995 - Form 7

FORM -7
[(See rule 4(2) (b)] 

I, Mr/ Mrs./Miss.....................................................................having lawful possession of the deadbody of Mr/ Mrs./Miss............................................................son of/ daughter of / wife of ..................... ............ aged .................................. resident of ........................................after having known that the objection was expressed by the deceased to any of his human organs being used after is death for therapeutic purposes and having reason to believe of deceased person has objection to any of the deceased person's organs being used for therapeutic purposes, hereby authorise the removal of the deceased’s organ, namely, ………………………………………………. for therapeutic purposes. 

Signature........................................................

Name..............................................................
Address..........................................................
.......................................................................
Time and Date ……………………………...