Accident Detail Receipt
Date And Time 24-Dec-2017 / 8:00 am
Place of Accident Zhirnipada to chhadvel way
CR NO/ TAR No/ SDE NO 03/2018
Name of the Injured/ Deceased Punjai shamrav sable, age. 17, at. Zhirnipada, tal sakri, dist. Dhule
Name of The Hospital to which he/she was removed Chivil hospital dhule
Number of vehicle and type of the vehicle Bajaj pletina motar cycal Mh 12 dn 8792
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. Punjai shamrav sable, age. 17, at. Zhirnipada, tal. Sakri, dist. Dhule
Name of the owner of the vehicle as it stand on the date of the accident Shamrav manya sable, at. Zhirnipada, tal. Sakri, dist. Dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Nill
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Nill
Action Taken if any, and the result thereof. Abett final
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