Sign up for donating your eyes

Please print out the following form and fill it in and mail it to the Eye Bank Society in order to sign up as an eye donor.

Alternatively, fill in this form. When you do so, an email will be sent to the Eye Bank Society Chandigarh who will mail you a form that you can fill in and return to the Bank.

If you face any difficulty in filling out or submitting this form, please email eyepgi@ch1.dot.net.in with the relevant details.

I hereby bequeath my eyes after my death to Eye Bank of the PostGraduate Institute of Medical Education and Research, Chandigarh.

I solemnly affirm that the above is binding on my nex of kin / heir

Your Name     : 

Email Address : 

Address       :   

City          :       Country : 

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