Accident Detail Receipt
Date And Time 17-Jan-2018 / 6:30 pm
Place of Accident IN HOL SHIVAR NEAR AMARDHAM ON ROAD TAL SHINDKHEDA DIST DHULE
CR NO/ TAR No/ SDE NO 04/18, SDE NO 33/23:17 IPC 304(A), 279,337,338 MV ACT- 184,134/177
Name of the Injured/ Deceased GOPAL SHANTARAM CHAUDHARI, AGE 49, RATHGALLI SHINDKHEDA TAL SHINDKHEDA DIST DHULE
Name of The Hospital to which he/she was removed PHC SHINDKHEDA. DIST DHULE.
Number of vehicle and type of the vehicle 1) MH18 AQ 0608 MOTOR CYCLE 2) MH18 BB 2203 MOTOR CYCLE
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) GOPAL SHANTARAM CHAUDHARI, RATHGALLI SHINDKHEDA TAL SHINDKHEDA DIST DHULE 2) PRAVIN POPAT PATIL, AT BABHULDE TAL SHIRPUR, DIST DHULE
Name of the owner of the vehicle as it stand on the date of the accident 1) GOPAL SHANTARAM CHAUDHARI- MH18 AQ0608 2) PRAVIN POPAT PATIL . MH18 BB 2203
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. 2) UNITED INDIA INSURANCE CO. LTD. AGENCY BROKER CODE : AGI0035767, VRUSHALI ASHISH LONKHEDE DO CODE - 26538
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 2) 2313003116P115120874
Action Taken if any, and the result thereof. CR NO. 04/18 IPC 304(A), 279, 337, 338 MV ACT 184, 134/177
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