Accident Detail Receipt
Date And Time 18-Jul-2017 / 5:30 am
Place of Accident Natinal highway Mumbai Agra -03 distance from songir police station southrn side 4 km.
CR NO/ TAR No/ SDE NO 69/2017
Name of the Injured/ Deceased 1) (Death-)Bhikan Ram sonawane 1) Injured-Nandalal Gamlal Thakre 2) Shashikapoor Ram sonawane at post Subgavhan tal paroda dist jalgaon
Name of The Hospital to which he/she was removed civil hospital dhule
Number of vehicle and type of the vehicle 1) Auto-reksha MH-04 /BG 7961 2) indica kar no.MH-18 02/PA 4975
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) Hira nic name Hiralal Banjara (Chavhan) At dalwel tal paroda dist jalgaon RTO- Jalgaon
Name of the owner of the vehicle as it stand on the date of the accident Hiralal nic name Hiralal Banjara(chavhan) At dalwal tal paroda dist Jalgaon
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. orinetal insurance company LTD
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 182600/31/2018/990
Action Taken if any, and the result thereof. Arrest him date 9/08/2017 time 12.47
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