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Jadilah Pengikrar Pendermaan Organ Dan Tisu Dengan Mengisi Maklumat Di Bawah

1. MAKLUMAT PERIBADI ANDA

Nama K/P Lama K/P Baru Tarikh Lahir Bangsa Jantina Alamat

Borang Pendaftaran Pendermaan Organ Nasional

No. Tel Emel

2. WARIS
Nama Hubungan

3. LANGKAH SETERUSNYA
Anda perlu memberitahu pihak keluarga mengenai keputusan anda untuk mendermakan organdan tisu selepas kematian.

4. HASRAT ANDA
Saya berharap dapat mendermakan :a. Semua organ dan tisu b. Atau Buah pinggang Jantung Untuk tujuan transplantasi. Hati Paru-paru Mata Tulang Kulit

Tandatangan

Tarikh

TERIMA KASIH

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