Accident Detail Receipt
Date And Time 26-Jul-2017 / 10:30 pm
Place of Accident NATIONAL HIGH WAY NO 6 SURAT-NAGPUR ON BEHIND OF NEW ENGLISH SCHOOL SAKRI
CR NO/ TAR No/ SDE NO CR NO 91/2017 IPC 304(A) 279,337,338,427 MVA 184
Name of the Injured/ Deceased SAGAR MAGAN PANCHARAS 23 YEAR OLD AT POST GADHI BHILATI TAL SAKRI DIST DHULE
Name of The Hospital to which he/she was removed RURAL HOSPITAL SAKRI
Number of vehicle and type of the vehicle 1) KANTENAR NL-01-L-1397 2) MOTERCYCLE NO MH-18-BB-9163
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) NL-01-L-1397 DRIVER NAME - SANTOSH JAGADISH YADHAV 36 YEAR OLD AT POST-DOHALA TAL-NARADIGANJ-DIST-NAVADA (BIHAR) 2)MH-18-BB-9136 DRIVER NAME- SAGAR MAGAN PANCHARAS 23 YEAR OLD ATPOST-GADHI BHILATI TAL-SAKRI DIST-DHULE
Name of the owner of the vehicle as it stand on the date of the accident 1) NL-01-L-1397 OWNER NAME- EFC-LOGISTICS INDIA PVT LTD 2) MH-18-BB-9163 GANESH TRAMBAK MORE ATPOST SAKRI TAL SAKRI 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) NL-01-L-1397 INSURANCE - NATIONAL INSURANCE COMPANY LIMITED ADD- JEEVAN SUDHA 6TH FLOOR 42C JAWAHARLAL NEHARU ROAD KOLKATA 700071 2) MH-18-BB-9163 INSURANCE- ICICI LOMBARD MOTOR INSURANCE COMPANY LTD ADD- 414 VEER SAVARKAR MARG NEAR SIDDHI VINYAK TEMPALE PRABHADEVI MUMBAI
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1) NL-01-L-1397 -101800311610000074 2) MH-18-BB-9163-3005/36178847/10926/000
Action Taken if any, and the result thereof. 1) THE ACCUSED WAS ARRESTED 2) DAR FORM FULLFILL
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