Ramayamma International Eye Bank

In the hope that may help others I hereby make this gift, if medically acceptable, to take effect upon my death. The submission in the form indicates my desires.

I give my eyes for the purpose of transplantation, medical research or education.

I further direct my next of kin, herein named, to execute this gift after my death.

 
 
I would like my next of kin notified of my pledge to donate my eyes.*
 
 
 
 
 
 
 
 
 
 
Kin Address  Same as Donor  Not Same
 
 
 
 
 
 
 
 
 

Fill in the attached donor pledge card as per the instruction.

Discuss your decision with your next of kin and other family members. We will inform your next of kin of your pledge if you wish.

Email the completed card to: rieb@lvpei.org

For any further details, you can visit/ call

Ramayamma International Eye Bank

Kallam Anji Reddy Campus,

L V Prasad Eye Institute (LVPEI)

L V Prasad Marg, Hyderabad 500 034, India

Contact 24 hours phone:1919(Toll free); 2354 8266 (direct);
 3061 2514/30612345
 Mobile: 98495 45822

We will send you a wallet card stating your pledge and informing your next of kin of your desire. Please carry the wallet card with you at all times. If you change your name or address, do inform the Ramayamma International Eye Bank immediately.