Accident Detail Receipt
Date And Time 27-Mar-2018 / 12:42 pm
Place of Accident On Mumbai Aagra Mahamarg 3, Dhule To Shirpur Road, Near Gorane Fata, Public Place Tal- Shindkheda Dist- Dhule
CR NO/ TAR No/ SDE NO 23/2018 SDE NO- 14/12:42 IPC 279,337,338,427 Mv Act- 184
Name of the Injured/ Deceased 1) Laxmikant Pundlik Sonawane Age- 35 A/P - Near Janta High School Shindkheda Dist- Dhule
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) Contenar :- NL 01-N-1301 2) Moter Cycle :- MH-18-AS- 2544
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 :- Hemchandra Jilesing Chaudhary Age- 32 A/P- Assonda Shivan Dist- Jazzar Hariyana 2) Motar Cycle :- Laxmikant Pundlik Sonawane Age- 35 A/P - Near Janta High School, Shindkheda
Name of the owner of the vehicle as it stand on the date of the accident 1) Contenar :- Vijay Logistics Private Ltd. Ad- A.G. Road Kohima , Nagaland 2) Motar Cycle :- Do Not Available
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. 1) Contenar :- Universal Sompo General Insurance Ltd. Unit 401 Fourth Floor, Sangam Comlex , Andheri East Mumbai Division Off:- Gurgaon Branch Office Hariyana 2) Motar Cycle :- Do Not Available
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1) Contenar :- Policy No:- 2315/57470806/00/000 Validity:- 04.08.2017 to 03.08.2018 2) Motar Cycle :- Do.Not Available
Action Taken if any, and the result thereof. Underr Investigation

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