Accident Detail Receipt
Date And Time 05-Nov-2017 / 8:00 pm
Place of Accident NEAR DHIWAD GOAN, ON MUMBAI TO AGRA ROAD ,NEAR ARTI HOTEL
CR NO/ TAR No/ SDE NO 88/2017 IPC 304 A,279,338,427 R/W MC ACT 184
Name of the Injured/ Deceased LAXMAN SAMBHU SHIRSATH AGE 35 JE AHILYAPURA TAL- SHIRPUR DIST- DHULE
Name of The Hospital to which he/she was removed K.E.M HOSPITAL MUMBAI
Number of vehicle and type of the vehicle 1) MH 15 EM 0884 MOTOR CYCLE( ACUSE VEHICLE) 2) MH 18 AB 5604 MOTOR CYCLE
Name of address of driver of the vehicle with perticuler ordriving license of the said driver and the address of the issuing Authority of the said driver license. The number of badge in case of public service vehicle and the address of the issuing Authority of the said badge. 1) VISHWADEEP MADHUKAR PATIL AGE 22 ADD- NEAR MOTI BHAWAN 12 BUNGLOW MALEGOAN DIST- NASHIK ISSUING AUTHORITY- MH41201568 LICENCE NO- MH4120150000634
Name of the owner of the vehicle as it stand on the date of the accident PATIL MADHUKAR RUPSINGH PLOAT NO 9 SHREE KRUSHANA APPART. 86/8 NEAR DREAM CASTLA MAKHMALABAD ROAD NASHIK
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. NO INSURANCE
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate NIL
Action Taken if any, and the result thereof. FILLUP CHARGESHEET TO COURT RESULT COURT PEANDING
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