Accident Detail Receipt
Date And Time 16-Nov-2017 / 6:49 pm
Place of Accident Mumbai Aagra Mahamarg 03, On Dhule to Shirpur Road , Near Kalmadi Fata, Tal Shindkheda Dist- Dhule
CR NO/ TAR No/ SDE NO 96/2017 SDE NO- 37/18:49 , IPC 279,337,338,427 MV ACT 184, 134/177
Name of the Injured/ Deceased 1) Ramdas Naval Shinde Age -60 A/P Pimparkheda Tal Shindkheda Dist- Dhule 2) Yahiya Riyaj Khan Age- 35 A/P - Gopalpura Pratapgad (U.P)
Name of The Hospital to which he/she was removed 1) Seva Super Specility Critical Care Dhule 2) Civil Hospital Dhule
Number of vehicle and type of the vehicle 1) Contenar :- NL-01-AA-0871 2) Motar Cycle :- MH-18-AD-1656
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) Contenar Drivar :- Yahiya Riyaj Khan Age- 35 Gopalpura Pratapgad(U.P) Licence No- UP7220130005056 RTO :- RATAPGAD (U.P) 2) Motar Cycle :- Ramdas Naval Shinde Age- 60 A/P - Pimparkheda Tal- Shindkheda Dist- Dhule Licence NO :- Do Not Licence Available
Name of the owner of the vehicle as it stand on the date of the accident 1) Contenar :- NYK AUTO LOGISTICS INDIA PVT LTD Upper Chandmari Nagaland Kohima 2) Motar Cycle :- Dattu Ramdas Shinde Age 33 A/P Pimparkheda Tal Shindkheda Dist- Dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. 1) Contenar :- United India Insurance Company Limited 24 Whites Road Chennai Division Offoce: -914/915 Burhani Mention Netaji Subash Chandra Road Tapal Naka Panvel, Maharashtra 2) Motar Clcle :- Baja Alliinz G E plaza Airport Road Yervada Pune Division Road :- 1 floor Shree Ganesh Plaza Near mahamarg Bus Stand Nashik
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1) Contenar :- Policy No:- 1210013116P118158281 Validity :- 27.03.2017 to 26.03.2018 2) Motar Cycle :- Policy No :- mc1000612043 Validity :- 15.10.2010 to 14.10.2011
Action Taken if any, and the result thereof. Under Investigation

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