Let your eyes be ‘Immortal’, Pledge them to see the light of tomorrow*
EYE PLEDGE FORM
Name, Age and Signature of Adult Family Members who wish to pledge eye for donation as family commitment are given below:
S.No Name Age Sex Contact No.
1.
2.
3.
4.
5.
To be filled in by four witness (neighbours or friends)
Name Location Contact No.
1. Witness 1
2. Witness 2
3. Witness 3
4. Witness 4
The filled forms will be sent to Eye Bank Association of India, Hyderabad.
