Accident Detail Receipt
Date And Time 27-Aug-2017 / 3:30 pm
Place of Accident Dondacha to indve way
CR NO/ TAR No/ SDE NO 71/2017
Name of the Injured/ Deceased Vinod shivaji indish, age.23, at. Indave, tal. Sakri, dis. Dhule
Name of The Hospital to which he/she was removed PHC Jaitane, tal. Sakri dist. Dhule
Number of vehicle and type of the vehicle Truck mh 18 m 5264
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. Kishor prbhakar patil, at. Bamne, tal. Shindkheda, dist. Dhule
Name of the owner of the vehicle as it stand on the date of the accident Anil ratanlal kotecha, age. 50, at. June dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Shree Raam vima compny , dhule
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 03.07.2017 to 02.07.2018
Action Taken if any, and the result thereof. Court pending

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