Accident Detail Receipt
Date And Time 20-Oct-2017 / 12:15 pm
Place of Accident Songir Area National Highway Mumbai Agra -03 Waghali phata distance songir police station Northern 3 K.M.
CR NO/ TAR No/ SDE NO 118/2017
Name of the Injured/ Deceased 1) Ishwarsing Ambarsing Girase 2) Pankajkumar rasad At post jawkhede tal Amalner Dist jalgaon
Name of The Hospital to which he/she was removed Civil Hospital Dhule
Number of vehicle and type of the vehicle 1) Two Wheeler MH-18 19 C.D.7837 2) Tacker no. K.A.02.5227
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. Nagaraj K kumar Swami N.Arban co-operative V nagar Hiropur Dist Chitradurg (Karnataka)
Name of the owner of the vehicle as it stand on the date of the accident Nageraj K Kumar Swami N.Arban co-operative V Nagat Hiropur Dist Chitradurg (Karnataka)
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. Nagaraj k Kumar Swami Arrest him 23.10.2017
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