Notice of accident (Regulation No. 65)

To

………………….
…………………..

I, ………………………….. son of ………….………………………., aged about ……………years r/o………….…………………….. a Junior engineer of the ……………………department of the ……………….Factory lost my right Hand in an accident on …………….at ……….a.m., at the Factory premises while on duty.

Sri…………………..…………… son of ……………………… of the ………………… Wing and Sri……………………… son of ……………………. of the …………………… Wing, both Junior Engineer in the ……………………. Wing of the said …………………. Factory were present at the spot when the accident happened.

The policy of Insurance bears No