E-Pledge

Be a Hero in Someone’s Eyes

You too can change lives and literally become a hero for others simply by deciding to sign a donor card pledging your eyes or corneas after death. Below is the Eye Donor Form which you can fill-up.

After submitting the Eye Donor Form, a Donor Form Code will be sent to your e-mail giving you access to print your temporary donor card. Have it signed by your indicated witnesses, discuss your decision with your family, and keep the donor card with you all times.

Checkout Donor Form Code

Enter Donor Form Code to checkout your card.

Eye Donor Form Content

Sign the pledge form and the Donor Card and make sure to have them signed by two witnesses.

First name

Please provide your first name.

Middle Initial

This is optional don't worry

Last name

Please provide your last name.

Gender

Male

Female

BirthDate

Please provide your birthdate.

I want to donate my

Eyes

Corneas

E-mail Address

Please provide a valid email address.

Contact Number

Please provide your contact no.

Witness Name

Please provide the witness #1 name.

Relationship to Donor

Please provide the relationship to donor.