Accident Detail Receipt
Date And Time 16-Dec-2017 / 4:00 pm
Place of Accident SAKRI PIMPLNER ROAD SHENPUR FATA
CR NO/ TAR No/ SDE NO CR NO 149/2017 IPC 304(A),279,337,338,427 MVA 184
Name of the Injured/ Deceased YOGESH MUKUNDA SHEVALE 26 YEARS OLD AT POST SHENUPUR 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 NEW MOTERCYCLE
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. YOGESH MUKUNDA SHEVALE 26 YEAR OLD AT POST -SHENPUR TAL-SAKRI DIST-DHULE
Name of the owner of the vehicle as it stand on the date of the accident MUKUNDA TULSHIRAM SHEVALE AT POST- SHENPUR 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. ICICI LOMBARD MOTER INSURANCE 414 VEER SAVARKAR MARG NEAR SIDDHI VINAYAK TEMPLE PRBHADEVI MUMBAI 400025
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 3005/39073117/10926/000
Action Taken if any, and the result thereof. DAR FULLFILL

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