I/We, hereby declare that I/we have gifted our eyes to the Nation for Sight Restoration purpose after my/our death. I/We have cast a responsibility on my/our relatives to invite a doctor from the nearest eyebank within 6 hours of my/our death for removal of my/our eyes to help me/us to fulfill this noble desire.

INSTRUCTIONS:
	Please close tightly the eyelids of the person immediately after death so that no dust should go inside the eyes. Cover the eyes with a piece of clean cloth dipped in cold water.
	Keep some pieces of ice in a thin plastic cover on the forehead and keep on changing them as they melt.
	Keep a pillow below the head of the dead person.
	Switch off the fans in the room where the dead body is kept.
	Ring up the nearest Eye Bank as early as possible when the eyes are fresh (maximum within 6 hours after death). Eyes are collected day or night at the donor's place, free of cost. The face is not disfigured and it takes only 15 minutes.
	You need not send this form anywhere for registration purpose. Hang this form in a prominent place at your home so that everyone knows your wish.

Signatures of the Eye Donors in the family, relatives or friends:

1............................     4............................

2............................     5............................

3............................     6............................

 

Date:                                                                              My Signature

 

EYE BANKS

Eye Banks are located in every major cities. Get in touch with the nearest hospital for the exact information about the nearest Eye Bank