bharat eye bank
A social initiative of BharatMatrimony
Eye Pledge form

Congratulations! on taking the first step in spreading the gift of sight. We can assure you there can be no other cause that is nobler. Please fill out these details below and we will send across this information to the nearest eye bank, which will then provide you with the eye pledge card.

More importantly, please ensure all your family members, near and dear ones are informed about your desire to donate your eyes, because if they do not give their consent, this pledge form will be rendered useless.


Name

Age

Gender
 Male          Female

Address

State

City

Pincode

Phone

E-mail

* Please allow 4 to 6 weeks for the
delivery of your eye pledge card.

Locate Your Nearest Eye Bank




Note: Due to frequent changes in telephone numbers, there could be errors in the numbers listed here. Kindly consult the local telephone directory or information center for the changed telephone numbers. Also, in case you come across a number that has changed or is non-existent, please do mail us the changed number so that we could update these records. Thank you.

Pledge
your eyes


Pledge your eye and become a sight ambassador. >>