Apply for cord blood donation

Request form

Via the form on this page you request an application form to donate umbilical cord blood.

Please note: Due to limited resources (such as the training of midwives and gynecologists), it is only possible to donate cord blood in a hospital or birthing center that collaborates with the Cord Blood Bank of Sanquin.

Due date

Please fill in your estimated due date here.

In which hospital will you be giving birth?

You can only donate cord blood if you are going to give birth at the Bravis Hospital in Bergen op Zoom, the Reinier de Graaf Gasthuis in Delft, or OLVG Oost in Amsterdam.

Your midwife or gynecologist

Fill in the name of the midwife or gynecologist who is overseeing your care here.

Contact information

First name

Prefix

Last name

As stated on your ID.

Your date of birth

With your date of birth, we can find you in our system.

Phone number

Emailaddress

I voluntarily give permission to the Sanquin Umbilical Cord Blood Bank to collect umbilical cord blood and make it available for the treatment of patients. I understand that by doing so, I cannot claim the product for myself.

Optional: If the umbilical cord blood is not suitable for the treatment of patients, I agree that the donated blood will be used for scientific research in recognised research institutes.