STATE ORGAN AND TISSUE TRANSPLANT ORGANIZATION (SOTTO)
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Donor Card Registration
Personal Details:
First Name :
*
Surname :
*
Father/Husband Name :
*
--Select--
S/O
D/O
W/O
Date of Birth :
*
Gender :
*
Male
Female
Age :
*
BloodGroup :
*
--Select--
A
B
AB
O
Mobile Number(self) :
*
Email :
Identity Proof :
*
--Select--
Aadhar card
Passport
PAN Card
Voter ID
ID NO :
*
Address Details:
Address :
State :
*
Select State
ANDAMAN & NICOBAR ISLANDS
ANDHRA PRADESH
ARUNACHAL PRADESH
ASSAM
BIHAR
CHANDIGARH
CHHATISGARH
DADRA & NAGAR HAVELI
DAMAN & DIU
DELHI
GOA
GUJARAT
HARYANA
HIMACHAL PRADESH
JAMMU AND KASHMIR
JHARKHAND
KARNATAKA
KERALA
LAKSHADWEEP
MADHYA PRADESH
MAHARASHTRA
MANIPUR
MEGHALAYA
MIZORAM
NAGALAND
ODISHA
Outside India
PONDICHERRY
PUNJAB
RAJASTHAN
SIKKIM
TAMIL NADU
TELANGANA
TRIPURA
UTTAR PRADESH
UTTARANCHAL
WEST BENGAL
City :
*
Address :
*
Pincode :
*
Emergency Contact Details:
Name :
*
Relation :
*
Select Relation
Father
Mother
Brother
Sister
Son
Daughter
Spouse
Grand Father (Paternal)
Grand Mother (Paternal)
Grand Father (Maternal)
Grand Mother (Maternal)
Others
Husband
Wife
In Case of other Relation :
Email :
Mobile Number(relative) :
*
Pledge Details:
ORAGAN(S) TO PLEDGE
*
ALL
LIVER
KIDNEY
HEART
PANCREAS
LUNG
TISSUE(S) TO PLEDGE
*
ALL
BONE
HEART VALVE
SKIN
CORNEA
CARTILAGE
I have informed my near relative/family member regarding my pledge to donate my Organ(s) and/or Tissue(s) after being declared my brain stem death.
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