Accident Detail Receipt
Date And Time 24-Sep-2017 / 2:50 pm
Place of Accident 109/2017
CR NO/ TAR No/ SDE NO 109/2017
Name of the Injured/ Deceased Balu ramdas Wakada age 35 a adersa leading de.dhule
Name of The Hospital to which he/she was removed --
Number of vehicle and type of the vehicle My.18.f.7519
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. -----
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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