Form J - Agreement For Surrogacy (Page 2 of 4) in pdf

Form J - Agreement For Surrogacy Page 2

I consent to the above procedures and the administration of such drugs that

may be necessary to assist in preparing my uterus for embryos transfer, and for

support in the luteal phase.

I understand and accept that there is no certainty that a pregnancy will result

from these procedures.

I understand and accept that the medical and scientific staff can give no

assurance that any pregnancy will result in the delivery of a normal and living

child.

I am unrelated / related (relation) ___________________________________ to

the couple (the would-be genetic parents).

I have worked out the financial terms and conditions of the surrogacy with the

couple in writing and an appropriately authenticated copy of the agreement has

been filed with the clinic, which the clinic will keep confidential.

I agree to hand over the child to __________________________, or

______________________________ and _____________________ in case of

a couple, or to ______________________________ in case of their separation

during my pregnancy, or to the survivor in case of the death of one of them

during pregnancy, or to _________________________________ in case of

death of both of them, or to _______________________________________ in

case of guarantor of foreign couple or individual, as soon as I am permitted to

do so by the hospital / clinic / nursing home where the child is delivered.

I have been provided with the written consent of all of those name(s) mentioned

above.

I undertake to inform the ART Clinic, _________________________, of the

result of the pregnancy.

I take no responsibility that the child delivered by me will be normal in all

respects. I understand that the biological parent(s) of the child has / have a

legal obligation to accept the child that I deliver and that the child would have all

the inheritance rights of a child of the biological parent(s) as per the prevailing

law.

Form J - Agreement For Surrogacy Page 2