Form J - Agreement For Surrogacy Page 4
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4_______________________________ the details and implications of his / her /
their signing this consent / approval form, and made sure to the extent humanly
possible that he / she / they understand these details and implications.
Signed:
*Signed:
(Surrogate Mother)
(Surrogate Husband)
Name, address and signature
of the Witness from the clinic
Name and signature of the Doctor
Name and address of the ART clinic
Dated:
* (Note:- In case of Divorced, Separated & Widow Signature of husband is not
required.)
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