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COVID-19 Plasma
Blood
Support Us
COVID-19 Plasma
Blood
Support Us
Plasma Donor Form
COVID Donor
Full Name
*
Gender
*
M
F
Age
*
Yrs
Mnth
Days
Personal Details
+90
+30
+98
+62
+ 1
+55
+7
+84
+380
+91
+234
+39
+63
+ 46
+48
+ 94
+ 371
+ 7
+355
+58
+92
+233
+40
+966
+81
+ 40
+1
+880
+213
+ 84
+60
+212
+41
+ 389
+351
+971
+ 31
+ 380
+ 90
+27
+ 375
+ 234
+ 98
+49
+ 82
+ 33
+593
+256
+255
+375
+66
+33
+ 92
+ 49
+44
+970
+ 61
+82
+43
+228
+ 62
+386
+967
+ 971
+ 966
+ 55
+95
+ 95
+356
+46
+ 66
+86
+20
+381
+54
+ 962
+ 65
+94
+225
+ 81
+ 43
+254
+ 30
+374
+32
+ 44
+258
BG
BH
BZ
BM
IN
ID
NP
TL
Have you tested positive for Covid-19?
*
Y
N
Date of positive COVID-19 test?
*
Do you have COVID-19 negative test report?
*
Y
N
Date of negative COVID-19 test report?
*
Address
*
City
*
Have you donated before?
*
Y
N
Blood Group
*
A+
B+
O+
AB+
A-
O-
B-
AB-
Organisation Name
Organisation
*
Select
Alpla
Cyient
Biological E Limited
Dr.Reddy's
Dodla Dairy
Elico
Hyderabad Runners
Infosys
Quantela
MYK Arment
MYK Laticrete
Paradigm IT
Srinivasa Farms
Zen Technologies
Other
Have you ever had a positive test for AIDS virus?
*
Y
N
Do you have any chronic conditions or anything else we need to know?
*
Have you ever been tested positive for Hepatitis B or Hepatitis C?
*
Y
N
Did you get a tattoo in the past 12 months?
*
Y
N
Would you be more inclined to donate if the user provides transportation?
*
Y
N
*
I have read and agreed to Terms and Conditions by GiveRED
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Policy Start Date
Policy End Date
Insurance Company
Apollo Munich Health Insurance Company Limited
Star Health and Allied insurance Co Ltd
Future Generali India Insurance Company Ltd
Bajaj Allianz General Insurance Co Ltd
Cigna TTK
National Insurance Co. Ltd.
Iffco Tokio General Insurance Co Ltd
The New India Assurance Co Ltd
The Oriental Insurance Co. Ltd
Reliance General Insurance Co Ltd
United India Insurance Co Ltd
Royal Sundaram Alliance Insurance Co Ltd
Tata AIG General Insurance Co. Ltd.
Cholamandalam MS General Insurance Co Ltd
HDFC ERGO General Insurance Co Ltd
Universal Sompo General Insurance Co Ltd
Bharti AXA General Insurance Co Ltd
SBI General Insurance Company Ltd
Raheja QBE General Insurance Co Ltd
MAX Bupa Health Insurance Company Ltd
Religare Health Insurance Co Ltd
Liberty General Insurance
Export Credit Guarantee Corporation of India Ltd. (ECGC)
Agriculture Insurance Co. of India Ltd.
Shriram General Insurance Company
Magma HDI General Insurance Company Limited
Ayushman Bharat
Arogya Sri
Is Group Policy?
Yes
No