Accident Detail Receipt
Date And Time 04-Jul-2017 / 8:00 pm
Place of Accident NIZMPUR TO KONDAIBARI ROAD KONDAIBARI SHIVAR
CR NO/ TAR No/ SDE NO CR NO 77/2017 IPC 279,337,338,427,MVA 184,3/181,21(20) /177
Name of the Injured/ Deceased 1) VIJAY PRAKASH GAVALI 2) SANGITABAI PRAKASSH GAVALI 3) BULABAI CHITAMN GAAVIT 4) GANESH SHIVAJI GAVALI 5) BHAGABAI SHAKAR GAVALI 6) SUSHILABAI BAJIRAV BAGUL
Name of The Hospital to which he/she was removed 1) RURAL HOSPITAL SAKRI 2) SHREE SAI ACCIDENT HOSITAL SAKRI
Number of vehicle and type of the vehicle SCORPIO NO MH-18-W-9633 AUTO RIKSA MH-18-AJ-4523
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. SCORPIPO NO MH--18-W9633 DRIVER NAME- AMRUT BHAVRAO AHIRE 31 YEAR OLD AT POST- KURSWADE TAL-SAKRI DIST-DHULE AUTORIKSH MH-18-AJ-4523 DRIVER NAME- DEVENDRA KASHINATH GAVALI 35 YEAR OLD ATPOST-GULATARA TAL-SAKRI DIST-DHULE
Name of the owner of the vehicle as it stand on the date of the accident 1) SCORPIO NO MH-18-W-9633 OWNER NAME- RAMLAL TUKARAM JAGATAP ADDRESS- SUTARE PO DHANER 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. SCORPIO NO MH-18-W-9633 I- MOTOR POLICY SCHEDULE CUM CERTIFICATE OF INSURANCE ADDRESS- 2ND FLOOR DARE HOUSE NSG OSE ROAD CHENNAI 60001
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 3362/01263284/00/00
Action Taken if any, and the result thereof. THE ACCUSED WAS ARRESTED DAR FORM FULLFILL
FIR Download Document 1
MEDICAL CERTIFICATE Download Document 2

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