Accident Detail Receipt
Date And Time 01-Jan-1970 / 12:45 am
Place of Accident Shirpur Chopada Road Bhorkheda Village Near On Road
CR NO/ TAR No/ SDE NO 33/2017 IPC 279,337,338,427,MV Act 134/177,184
Name of the Injured/ Deceased Gulab Shaym Patil 2) Ashok Devram Patil 3) Nandlal Babulal Pawar 4) Mangalsing Tarachand Bhill 5) Arvind Pandurang Bhaviskar 6) Ravindra Lilachand Patil
Name of The Hospital to which he/she was removed 1) Cottage Hospital Shirpur 2) Shidheshwar Hospital Dhule
Number of vehicle and type of the vehicle 1) Truck No.GJ 01 AU-3796 2) Tata Majic MH 18 AJ 0132
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) Truck Driver Name Remanbhai R Makwana At.Amrapur Tal Maliya Hatina Dist Junagadh 362245 Draving Liecnce No.GJ1120090325383 Licence Athority Junagadh. 2) Tata Magic Driver Name Ahosk Deoram Patil AT.Post Tardi Tal Shirpur Dist Dhule 425405 Licence No.MH1920080016350 Issuing Authority
Name of the owner of the vehicle as it stand on the date of the accident 1) Truck Owner Name Dayatar Mathurbhai Madhav Nagar 3NB BRC Bhavan Amrapur Road At.Maliya Hatina Dist.Junagadh 2) Tata Magic Owner Name Ashok Devrom Patil At.Post Tardi Tal Shirpur Dist Dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. 1) Truck No.GJ 01 AU 3796 The New India Assurance co.LTD Adderss Junagadh (211300) 01 st floor Gokul Chambhar kalwa chowk Junagadh 362001 2) Tata Magic No MH 18 AJ 0132 United India Insurance Address Shri Dinesh Complex Agra Road Deopur Dhule Maharastra
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1) Truck Insurance Policy No.2113001160100016346 Date of th Validity 30/10/2017. 2) Tata Magic Policy No 2313003116N100304532 Validity 03/01/2018
Action Taken if any, and the result thereof. Invetigation Of Case Send To By The JMFC Court Shirpur

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