Accident Detail Receipt
Date And Time 15-Dec-2017 / 11:30 am
Place of Accident dhule city vishal estet board near chand shahawali baba darga samaor dhule
CR NO/ TAR No/ SDE NO dhule city c r no 03/2018 IPC 279 ,337,338,427,M.V.act.184,134/177
Name of the Injured/ Deceased 1) rajendra arjun mahajan age 39 add. 35 B vishal estate mil parisar Dhule 2) vijay bapu more add.35 B vishal estate mil parisar
Name of The Hospital to which he/she was removed Docter Zende hospital Dhule
Number of vehicle and type of the vehicle MH 18 B B 6907
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. UNKNOWN
Name of the owner of the vehicle as it stand on the date of the accident UNKNOWN
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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