Consent Form 捐贈表格

Kindly click the link below to print Voluntary Body Donation Consent Form.

請按以下連接鏈以打印正式大體捐贈意願表格。

https://drive.google.com/file/d/0B3mvBcIhGuwhWHNRU3puOFpGSVE/view?usp=sharing

如需要中文翻譯之大體捐贈意願表格內容作參考,可按以下連接鏈:

https://drive.google.com/file/d/0B3mvBcIhGuwhNGlGX2VQQnFTQ1U/view?usp=sharing

 

Note / 備註 : 

1.  2 Trustees and 1 Witness are required to sign the Form together

     with the Donor.

    捐贈意願表格需要2位信託人及1位見證人同時與捐贈者一起簽署。

 

2. Trustees and Witness should be assigned from Spouse, Children

    (aged 18 & above), Siblings and other relatives of Donor in that

    sequence.

    信託人及見證人需順序來自捐贈者的配偶、18歲及以上的子女、兄

    弟姐妹或其他親屬。

 

3. The following should be sent to us via courier service once

    completed:

    以下填妥資料需通過快遞服務寄給本中心

    (a)  Consent Form fully signed by Donor, Trustees and Witness.

          由捐贈者、信託人及見證人完整簽署的捐贈意願表格。

    (b)  Photocopy of IC of Donor, Trustees and Witness.

          捐贈者、信託人及見證人的身份證複印本。

 

4. Item 3 (a) & (b) should be couriered to the following address:

    以上第3 (a) 及 (b) 項目需快遞郵寄到以下地址:

Silent Mentor Centre

Department of Surgery, Level 2, Faculty of Medicine,

University of Malaya

Lembah Pantai

50603 Kuala Lumpur, Malaysia

Tel: (03) 7949 4957

 

5. A Short Message Service will be sent to Donor as acknowledgement

    of receipt of the signed Consent Form by Silent Mentor Centre.

   本中心收到完整的捐贈意願表格後,會通過短訊通知捐贈者。

 

6. A Body Donor Card will be issued and posted by ordinary postal

    service approximately 2 weeks after receipt of the completed

    Consent Form. A Short Message Service will be sent to Donor to

    notify the same. 

   在收到完整捐贈意願表格後的大約2個星期,本中心將通過普通郵件

   寄出大體捐贈卡給捐贈者,同時通過短訊服務通知捐贈者。