Schedule – 8
(Related Sub-section (1) and (2) of Section 10)
Consent Letter (Document) that has to be given by oneself or nearest
kin for Safe Abortion Service.
After receiving the full advice and counseling on the need of safe abortion
services, various techniques of abortion, the inherent risks in the abortion
services, its alternatives and in the practical aspects of it including the
advantages and disadvantages, (1) Myself or (2) As a nearest kin of the
pregnant woman, I have given this document of consent to receive the service
pursuant to Sub-section (1) or (2) of Section 10 of the safe abortion service
processes, 2060, to you Doctor/Health Worker …………………. .
Finger print of the thump Person giving consent,-
(Thumb Impression) Signature :–

(To the person who don’t Name and surname :–
know to make signature) (a) Person Receiving Service :–
(b) Nearest kin’s :–
Age :–
(a) Person Receiving Service :–
(b) Nearest kin’s :–
Address :–
District :–
Village/Municipality :–
Ward No. :–
Tole :–
Date :–