Accident Detail Receipt
Date And Time 01-Jul-2017 / 4:00 pm
Place of Accident State Road 06, Nardana to Betavad Road , In Front of M.S.E.B 132 k.v.Sub Station , Nardana Tal- Shindkheda Dist- Dhule
CR NO/ TAR No/ SDE NO 61/2017 SDE NO- 25/18:30 IPC 304 (A), 279, 337,338,MV ACT-184 ,134/177
Name of the Injured/ Deceased 1. Nana Fula Patil , Age- 42 (Death) A/P- Pimprihat Tal- Bhadgaon, Dist- Jalgaon
Name of The Hospital to which he/she was removed CIivil Hospital, Jalgaon
Number of vehicle and type of the vehicle 1. Mahindra Max :- MH-18-N-7809
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. Drivar Name:- Sunil Bhika Shinde Age- 44, A/P- Shindi, Tal Bhadgaon, Dist- Jalgaon Licene No:- MH19 20080014380 RTO :- Jalgaon Validity :- 16.01.2023
Name of the owner of the vehicle as it stand on the date of the accident 1. Devendra Aasaram Salunke Age- 37 A/P- Fhagne Tal & Dist- Dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Shriram Gneral Insurance Company Limited E-8, EPIP, SITAPURA INDUSTRIAL AREA JAYPUR RAJSTHAN 302022 Division Office:- BG 0000000003 M/S. STFC CORPORATE AGENT-CA0197
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Policy No:- 10003/31/18/03/7686 Validity :- 29.04.2017 to 28.04.2018
Action Taken if any, and the result thereof. Charge Sheet Submit

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