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It is confirmed by the order
The general director of joint-stock company ***
From "____" ____________

The statement.
I __________
______ births, паспорт: серия ________
It is given out (whom, when) ______________________________
I wish to become substitute mother. I understand that for this purpose I should pass clinical inspection.
I declare that has stated to the doctor of joint-stock company **** all data known to me about a condition of the health, hereditary, venereal, mental and other diseases in my family.
I understand that results of my inspection will be informed not only me. But also a married couple, suffering barreness.
I know that the pregnancy which has come out treatment can appear extra-uterine, многоплодной, and also can interrupt.
I am warned that pregnancy and childbirth can be accompanied by a number of complications.
During carrying out of this program I undertake to carry out all appointments of the doctor and strictly to follow its recommendations.
URGENTLY, IT IS NECESSARY TO HAND OVER TOMORROW ON WORK THE REPORT... HELP!!!!THANKFUL IN ADVANCE!!

By order
General Director of JSC ***
from "____" ____________

Statement.
YA__________
______ ________
granted (by whom, when )______________________________
I want to become a surrogate mother. I understand that for this I must pass the clinical examination.
I declare that outlined the doctor AB **** I have known all the details about his health, hereditary, STD, mental and other diseases in my family.
I understand that the results of my survey will be communicated not only to me. but a couple suffering from infertility.
I know that occurred as a result of treatment of ectopic pregnancy can be, multiples, and may hang.
I am also aware that pregnancy and childbirth may be accompanied by a number of complications.
during this program, I pledge to fulfill all prescription and strictly follow its recommendations.
URGENT, WE MUST WORK FOR TOMORROW submit a report, ..HELP!! Thank you in advance!