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Sample Affidavits 21-11-17.Doc

Ms. Gomathi, a 16-year-old suffering from end-stage liver disease, is set to undergo a liver transplantation with her elder brother, Mr. Manimaran, voluntarily donating a part of his liver. Both siblings have acknowledged the risks and complications associated with the procedure, with Mr. Manimaran offering his donation as a charitable act. Their father, Mr. Jothi, supports the donation and has no objections, understanding the associated risks.

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Durai.Balasundaram Tamil Nadu
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17 views

Sample Affidavits 21-11-17.Doc

Ms. Gomathi, a 16-year-old suffering from end-stage liver disease, is set to undergo a liver transplantation with her elder brother, Mr. Manimaran, voluntarily donating a part of his liver. Both siblings have acknowledged the risks and complications associated with the procedure, with Mr. Manimaran offering his donation as a charitable act. Their father, Mr. Jothi, supports the donation and has no objections, understanding the associated risks.

Uploaded by

Durai.Balasundaram Tamil Nadu
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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AFFIDAVIT​ ​(Patient)

I Ms. Gomathi D/o Mr. Jothi, age 16, by faith Hindu, Citizen of India, having present address:
T.​ ​Edaiyoor,​ ​Thirukkovilur​ ​Taluk,​ ​Thiruvallur.​ ​ ​Solemnly​ ​affirm​ ​and​ ​declare​ ​as​ ​follows.

1. I​ ​am​ ​the​ ​permanent​ ​resident​ ​and​ ​citizen​ ​of​ ​India​ ​by​ ​birth.
2. That I Ms. Gomathi, suffering from liver disease in its end stage and doctors has advised
Liver transplantation. The doctors have explained me regarding the complications possible
with living donor hepatectomy (partial liver removal) and liver transplantation. I accept the
potential​ ​problems.
3. My elder brother Mr. Manimaran decided to donate a part of her liver to me without taking
any​ ​charge,​ ​as​ ​a​ ​free​ ​gift,​ ​with​ ​pure​ ​good​ ​generous​ ​mood,​ ​as​ ​an​ ​act​ ​of​ ​good​ ​will​ ​and​ ​charity.
4. I have been clearly explained all the post operative complications by the doctors and I accept
all​ ​the​ ​potential​ ​problems​ ​involved​ ​in​ ​this​ ​liver​ ​transplantation.

The​ ​statements​ ​made​ ​above​ ​are​ ​true​ ​and​ ​correct​ ​to​ ​the​ ​best​ ​of​ ​our​ ​knowledge.
AFFIDAVIT​ ​(Donor)

I Mr. Manimaran, S/o Mr. Jothi, age 21, by faith Hindu, Citizen of India, having present
address: T. Edaiyoor, Thirukkovilur Taluk, Thiruvallur. Solemnly affirm and declare as
follows.

1. My younger sister Ms. Gomathi has end stage liver disease stage and doctors have
advised​ ​Liver​ ​transplantation.
2. As I am the brother of Ms. Gomathi, I am willing to donate a part of my liver for his
survival​ ​and​ ​mental​ ​sound​ ​condition.
3. I understand well, that by offering this liver charity, I was explained about all the risks
involved in donation of a part of my liver for transplantation and will suffer some pain
and illness, which I don’t mind anyway, and I can endure it. I am not charging him any
kind of fees, only giving in charity in good generosity. I admit and pledge that, I spare it
as sincere free charity gift. I make this declaration to the best of my knowledge and
belief.

Witness
AFFIDAVIT​ ​(Guardian)

I Mr. Jothi, S/o Mr. Vengatapathi Naidu, age 58, by faith Hindu, Citizen of India, having present
address: T. Edaiyoor, Thirukkovilur Taluk, Thiruvallur. Solemnly affirm and declare as
follows.

1. I​ ​am​ ​related​ ​to​ ​Ms.​ ​Gomathi​ ​and​ ​Mr.​ ​Manimaran​ ​as​ ​father.
2. My daughter Ms. Gomathi is suffering from end stage liver disease and she needs liver
transplantation.
3. My son Mr. Manimaran is willing to donate a part of her liver to his younger sister Ms.
Gomathi.
4. I take care of the entire family as the guardian and I have no objection at all if my son
Mr. Manimaran donates a part of his liver to his younger sister Ms. Gomathi in order to
save​ ​the​ ​life​ ​out​ ​of​ ​love​ ​and​ ​affection.
5. I am aware and explained of the risks involved in living liver donation and liver
transplantation​ ​and​ ​I​ ​wish​ ​them​ ​success​ ​and​ ​longevity​ ​in​ ​life.

The​ ​statements​ ​made​ ​above​ ​are​ ​true​ ​and​ ​correct​ ​to​ ​the​ ​best​ ​of​ ​our​ ​knowledge.

Guardian​ ​Name:
Address:

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