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Your Name:*
Contact No:*
Required Blood Group:*
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A positive(+)
A negative(-)
B positive(+)
B negative(-)
AB positive(+)
AB negative(-)
O positive(+)
O negative(-)
Amount(Unit/Bag):*
Patient's Present Location:
Patient's Present District:*
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Bagerhat
Bandarban
Barguna
Barisal
Bhola
Bogra
Brahmanbaria
Chandpur
Chapainababganj
Chittagong
Chuadanga
Comilla
Cox's Bazar
Dhaka
Dinajpur
Faridpur
Feni
Gaibandha
Gazipur
Gopalganj
Habiganj
Jamalpur
Jessore
Jhalokati
Jhenaidah
Joypurhat
Khagrachhari
Khulna
Kishoregonj
Kurigram
Kushtia
Lakshmipur
Lalmonirhat
Madaripur
Magura
Manikganj
Maulvibazar
Meherpur
Munshiganj
Mymensingh
Naogaon
Narail
Narayanganj
Narsingdi
Natore
Nawabganj
Netrakona
Nilphamari
Noakhali
Pabna
Panchagarh
Patuakhali
Pirojpur
Rajbari
Rajshahi
Rangamati
Rangpur
Satkhira
Shariatpur
Sherpur
Sirajganj
Sunamganj
Sylhet
Tangail
Thakurgaon
Date of Donation:*
Request Message:*
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