-----< H e a l t h y E y e >------Donate Your Eyes

In order to sign up as an eye donor, Please print out the following form and fill it in & send by mail to the State Eye Bank, Ram Lal Eye & E.N.T Hospital {Department of Ophthalmology, Govt. Medical College}, Majitha Road, Amritsar-143001(Punjab) .

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

If you face any difficulty in filling out or submitting this form, please email
bsdhillon@healthyeye.org with the relevant details.

I hereby bequeath my eyes after my death to the Eye Bank, Govt. Medical College,Amritsar.

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

Date & Signature

Your Name     :

Email Address : 

Address       :

Phone No.   :

City : Country :