Form J - Agreement For Surrogacy (Page 3 of 4) in pdf

Form J - Agreement For Surrogacy Page 3

I will not be asked to go through sex determination tests for the child during the

pregnancy and that I have the full right to refuse such tests. I will, however,

agree to foetal reduction if asked by the party seeking surrogacy, in case I

happen to be carrying more than one foetus.

I understand that I would have the right to terminate the pregnancy at my will,

under the provisions of the MTP Act; I will then refund all certified and

documented expenses incurred on the pregnancy by the biological parents or

their representative. If, however, the pregnancy has to be terminated on expert

medical advice, these expenses will not be refunded.

I have been tested for HIV, hepatitis B and C and shown to be seronegative for

these viruses just before embryo transfer.

I certify that (a) I have not had any drug intravenously administered into me

through a shared syringe; and (b) I have not undergone blood transfusion in the

last six months.

I also declare that I will not use drugs intravenously, or undergo blood

transfusion excepting of blood obtained through a certified blood bank on

medical advice.

I undertake not to disclose the identity of the party seeking the surrogacy.

In the case of the death or unavailability of any of the party seeking my help as

the

surrogate

mother,

will

deliver

the

child

______________________________ or ____________________________

in this order; I will be provided, before the embryo transfer into me, a written

agreement of the above persons that they will be legally bound to accept the

child in the case of the above-mentioned eventuality.

(If applicable) My husband has approved my acting as a surrogate.

(Strike off if not applicable.)

Endorsement by the ART Clinic

I / we have personally explained to ______________________________ and

Form J - Agreement For Surrogacy Page 3