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ocr99.txt
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ocr99.txt
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WMCUICAl ASSCOSMICUL FOI (Porn BD)
Application Number (if avatlable)..............c.ccsesccecsccoucoetescereveesecse cesses
'ClaimantName | CHINMAY SHirmpr
Address _ MAHATMA FULE NAGAR
CHANDWAD CNASWIK) |
Gender | MALE
‘Marital Status UNMARRIED
, Date of Birth |} (03) 1998
' Occupation | ENGINEER,
i Currently At Work Yes Cl
Height, | 6 FT :
_ Weight 60 KG |
-R/L Hand Dominant | YES |
Date of Accident 15-02-2019
‘ Date of Examination 16-02-2011
Brief details of the accident/incident