Eye Pledge Form

Family Eye Registration Pledge Form

In the hope that we may help others, we hereby make this anatomical gift of eyes
effective after my / our death for Transplantation / Medical Education

Sl. No. Name Age Sex Relationship Blood Group
1 MaleFemale
2 MaleFemale
3 MaleFemale

Head Of Family

Name:

Address:

Phone:

Email:

Write the following text in the box: captcha

Information On Eye Donation

  1. Eyes can be donated only after death
  2. Do not Burn or Bury Eyes, donate them
  3. An estimated 30 lac corneal blinds in our country are waiting for somebody to donate eyes
  4. One pair of eyes can give vision to two corneal blind individuals
  5. Eyes should be donated preferably within 6 hours from death
  6. Removal of eyes only takes 20 minutes and does not disfigure the face
  7. Eyes are collected / distributed free of cost
  8. Donor Eyes will be collected at Hospital, Residence, Mortuary or at the place of death
  9. If you come across dead, please gently explain to the bereaved family and motivate the family to donate eyes, Call the nearest Eye Bank for assistance
  10. All can donate eyes even if they are suffering from Diabetes, Cataract, Asthma or refractive errors.
  11. Eye pledging is not essential for eye donation