Accident Detail Receipt
Date And Time 24-Feb-2017 / 12:00 pm
Place of Accident dhule city
CR NO/ TAR No/ SDE NO dhule city cr no 44/2017
Name of the Injured/ Deceased shamkant raoji patil
Name of The Hospital to which he/she was removed hire medical college dhuel
Number of vehicle and type of the vehicle MH 18 M 8284
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. Dhananjay Shamdas Khairnar address dasera maidan dhule
Name of the owner of the vehicle as it stand on the date of the accident --
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. --
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate --
Action Taken if any, and the result thereof. --

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