Accident Detail Receipt
Date And Time 12-Apr-2017 / 1:30 pm
Place of Accident On Mumbai Aagra Mahamarg 3, Dhule to Shirpur Road, In Front Of Hotel Chaudhary Tal Shindkheda Dist- Dhule
CR NO/ TAR No/ SDE NO 36/2017 SDE NO- 14/13:30 IPC 304 (A) ,279,337,338,427 MV ACT 184
Name of the Injured/ Deceased 1) Chetan Mahesh Davane Age- 24 (Death Person) A/P- 73, Tapu nagar galli no 5 , Malvamil Indore (M.P) 2) Piyush Bajendranath Pande Age- 28 A/P - 49, Kitvariyaa Dist- Riva (M.P) 3) Pratima Trivedi Age- 40 A/P- Indore 4) Sushma Manoj Yadav Age- 44 A/P - Indore
Name of The Hospital to which he/she was removed P.H.C Nardana Tal shindkheda Dist- Dhule
Number of vehicle and type of the vehicle 1) Luxary Bus :- MP-30-T-9090 2) Eicher :- MP-09-GF-9391
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. l) Luxary :- Mohanlal Badriprasad Sharma Age- 28 A/P- Bapat Chauk, Sukliya Indore (m.p) Licence :-MP33R20160104674 RTO :- Shivpuri 2) Eicher:- Eftikhar Abdul Rashid Arshi Age- 35 A/P- Dhanjisha Marg Mahu, Indore (M.P) licence :- MP09R-2017-0104176 RTO; - Indore
Name of the owner of the vehicle as it stand on the date of the accident 1) Luxary :- Hari Prakash Dube Age- 45 A/P - Gallamandi Bhind ( MP) 2) Eicher :- Jahid Ulla Asad Ulla Age- 48 A/P- 7481, Kanchan Vihar Colony, Mahu
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. 1) Luxary :- Unitet India Insurance Com. Ltd. 4, Whites Road Chennai Division Office :- 91 Station Road Devaas 2) Eicher :- United India Insurance Com. Ltd Division Office:- 104-105-569 Rajni Bhavan M.G.Road Indore
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1) Luxary :- POlicy No:- 1913013116P116467808 Validity :- 02.03.2017 to 01.03.2018 2) Eicher :- Policy No:- 1903023116P109713161 Validy :- 22.10.2016 TtO 21.10.2017
Action Taken if any, and the result thereof. Under Investigation

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