donate blood

Please fill in your personal information
First Name *
Last Name *
Gender * Female     Male
Date of Birth *
Mobile *
Home Phone *
Email Address *
Address *
Blood Type *
Have you donated blood
or platelets: *
Yes     No
Last date of donation *
Comments *
Captcha *
captcha image
(antispam code: type in the 3 black symbols that you see)

Fields marked with (*) are required

"Thank you for your courage and determination... thank you for miracles and hopes "

Staff of Standard Chartered
Bank SAL, 2012