Accident Detail Receipt
Date And Time 03-Apr-2017 / 1:30 pm
Place of Accident deshvidesh hotel samor dhule
CR NO/ TAR No/ SDE NO dhule city 70/2017
Name of the Injured/ Deceased Mugali Ribina purna name mahit nahi
Name of The Hospital to which he/she was removed hire medical college dhule
Number of vehicle and type of the vehicle JH.9.S.4751 unknown draiwar
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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