Accident Detail Receipt
Date And Time 15-Dec-2017 / 3:00 am
Place of Accident In Nardana Mumbai- Agra No.3 Near Shakti saw mill. Tal. Shindkheda Dist Dhule.
CR NO/ TAR No/ SDE NO 107/2017 IPC 279,337,338,427 MVAct 134/177
Name of the Injured/ Deceased Dhansing Narsing Chavhan age 30 a/p pala apani Tal. Sendhwa Dist Badnami. And Other
Name of The Hospital to which he/she was removed Civil Hospital, Dhule And Sarah Multispeciality Hospital, Dhule
Number of vehicle and type of the vehicle UP 76 K 3416 Goods Vehicle MH 20 DE 4440 Goods 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. 1.Harnathsing Ravi prasad Sing Age 51 A/P Samsabad Tal Kayamganj Dist Farukhabad UP. 2. Bhagwan Gorakh Pawar (Marathe) Age 24 At.Manegaon Tal. Vaijapur Dist Aurangabad.
Name of the owner of the vehicle as it stand on the date of the accident Suresh Babu Ram bharosa Saxena Age 51 At Ghasiya Chiloli Tal. Kayamganj Dist Farukhabad.
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Shriram Finance 10003 Add. E-8 RIICO INDUSTRIAL AREA SITAPURA JAIPUR RAJASTHAN 302022.
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Policy No 10003/31/18/376215
Action Taken if any, and the result thereof. Nardana Police Station 5 CR No 107/2017 IPC 279,337,338,427 MVAct 134/177

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