Accident Detail Receipt
Date And Time 01-Oct-2017 / 1:23 pm
Place of Accident Dhule 40gonwa rod
CR NO/ TAR No/ SDE NO 112/2017
Name of the Injured/ Deceased ---
Name of The Hospital to which he/she was removed Dhule shiviLa Hospital
Number of vehicle and type of the vehicle ---
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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