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Eye Donor Registration
 
Name
:
*
*Gender
:
Male
 
Female
Date of birth
:
Select Date *
Weight (in Kg.)
:
Blood Group
:
*
State
:
*
City
:
*
Telephone (With STD Code Eg. 04742792819)
:
*
Mobile Number (10 Digits Only)
:
*
Address
:
E_Mail:
:
*Enter the letters from the image
 
Security Image

Tick here to Agree and then submit

I here by declare that information furnished above is true to the best to my knowledge. If any of the above information is found to be wrong, I will be solely responsible for anything resulting out of it and any loss or damage sustained to the Government or any other person or agency.

Copyright National Informatics Centre. All rights reserved
NIC HeadquartersNIC Kerala State UnitNIC Kollam District Unit 
Department of Information Technology,  Ministry of Communications and Information Technology Collectorate, Kollam  Phone : 91-474-2792819