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Judicial Service
>>Application for Organ Transplant Registration Form
NOTE: Label which are mark with * are mandatory fields, you cannot proceed further without those fields. Please follow the instruction in
Personal Details
Court & Contact Details
Attachment
Applicant Cid No:
Applicant Name:
Applicant Gender:
--SELECT--
Male
Female
Patient Cid No:
Patient Name:
Patient Gender:
--SELECT--
Male
Female
Relationship :
--Patient's relation with Donor-
Father
Mother
Uncle
Aunt
Grandfather
Grandmother
Brother
Sister
Son
Daughter
Nephew
Niece
Wife
Husband
Others
Donor Cid No:
Donor Name:
Donor Gender:
--SELECT--
Male
Female
Relationship:
--Donor's relation with patient--
Father
Mother
Uncle
Aunt
Grandfather
Grandmother
Brother
Sister
Son
Daughter
Nephew
Niece
Wife
Husband
Others
Donor Dep. Cid No:
Dependent Name:
Dependent Gender:
--SELECT--
Male
Female
Relationship :
--Dependent's reation with donor--
Father
Mother
Uncle
Aunt
Grandfather
Grandmother
Brother
Sister
Son
Daughter
Nephew
Niece
Wife
Husband
Others
Witness1 Cid No:
Witness1 Name:
Witness2 Cid No:
Witness2 Name:
Next
NOTE :
Please select the court you want to visit for hearing. And please provide correct mobile number to get SMS from court.
Mobile Number:
Email:
Present Address:
Court:
--SELECT--
Bumthang
Chukha
Dagana
Gasa
Gelephu
Haa
Lhuentse
Mongar
Pemagatshel
Phuentsholing
Paro
Punakha
Samdrup Jongkhar
Samtse
Sarpang
Trashi Yangtse
Thimphu
Trashigang
Trongsa
Tsirang
Wangduephodrang
Wamrong
Zhemgang
Dorokha
Jomotshangkha
Lhamoyzingkha
Lingshi
Nganglam
Panbang
Sakten
Samdrupcholing
Sibsoo
Sombeykha
Thrimshing
Weringla
Reason:
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Please note that all the below given list of documents must be attached and brought along with you during the date of appointment. Each person applying for the service must produce the following documents:
*
Copy of Citizenship Identity Card of the patient, donor, donor's dependent and the witnesses.
Nativity proof of patient, donor and donor's dependent from their respective gewog administration.
Relationship certificate of patient and donor.( Ministry of Home and Cultural Affairs )
Relationship certificate of donor and donor's dependent.
If the donor is either of the spouse, a copy of their marriage certificate.
Family tree of the donor and patient,(Ministry of Home & Cultural Affairs).
Donor's medical fitness letter issued by Jigme Dorji Wangchuck National Referral Hospital.
Letter from medical superintendent (Jigme Dorji Wangchuck National Referral Hospital) requesting legal affidavits for organ transplant.)
No objection letter from parents/spouse.
Scanned copy of a legally signed application stating the intent
The recent passport size photos in full National Dress. Patient -2Copies, Donor- 2Copies during date of appointment
Donor's Dependent - 4 copies during date of appointment
Joint photograph of the Patient and Donor - 2 copies during date of appointment
Joint photograph of the Donor and Dependent - 2 copies during date of appointment
Legal Stamp - 12 Nos. during date of appointment
Please attach required files if any:
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Judicial Service
>> Acknowledgement
Thank you for applying
. Your application number generated by system is
and this application is forwarded to
court for verification and approval. You may track your application status using this application number from Track Your Application.
Thank you.
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