Accident Detail Receipt
Date And Time 23-Sep-2017 / 7:10 am
Place of Accident Pimpri FAta Shirpur
CR NO/ TAR No/ SDE NO shirpur ps cr no-288/17 IPC 304A,279,337,338,427,R/W MV Act 184, 134/177
Name of the Injured/ Deceased Ratnabai Batesing Rajput 40 years old At post Ahilypur Tal Shirpur
Name of The Hospital to which he/she was removed Indira Hospital Shirpur
Number of vehicle and type of the vehicle Cantener No RJ14 GS 0200(Accuesd )
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. Umar Mohid isak At Post Vid Mevat Hariyana
Name of the owner of the vehicle as it stand on the date of the accident Umar mohid isak
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Nil
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Nil
Action Taken if any, and the result thereof. Fill Up chargeshit to court
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