Accident Detail Receipt
Date And Time 24-Dec-2017 / 9:00 pm
Place of Accident Devndra Rajput Road to the Road on the Road in Public On the Road in the Holnathe Village
CR NO/ TAR No/ SDE NO 03/2018 IPC 304(A),279,427 MV ACT 134/177,184
Name of the Injured/ Deceased Deceased Na,me Monaj Vishanath Patil Age 33 A/P Valoda Tal Chopada Dist Jalgoan
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur
Number of vehicle and type of the vehicle 1) Eicer Truck No MH 18M 7516 2) Motar Cycle No MH 18X 8208
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. Shaligram Bapu Patil A/P Louki Tal Shirpur Dist Dhule Draving Licence No MH 18 20060010423 2) Gulab Dongar Patil A/P Japora Tal.Shirpur Dist Dhule
Name of the owner of the vehicle as it stand on the date of the accident 1) Krishna Bajirao Patil A/P Vikharan Tal.Shirpur Dist Dhule 2) Gulab Dongar Patil A/P Japora 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. Bajaj Allianz Genaral Insurance Company LTD Jalgaon
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate EICHER TRUCK POLICY NO OG -17-2002-1831-00001071 DATE VELIDETY 02-03-2018
Action Taken if any, and the result thereof. INVESTIGATION

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