Accident Detail Receipt
Date And Time 06-Aug-2017 / 2:00 am
Place of Accident Ac Post Arthe villag Pleace Ashram School stat Ankleshwar -Barhanpur H/W no- Tal shirpur Dist Dhule
CR NO/ TAR No/ SDE NO Shirpur PS -cr no-237/2017 U/S IPC -304A 279,337,338,427, MV ACT- 184,134/177
Name of the Injured/ Deceased 1. Rajesh Purshuram Chouhan Age 30 AC Post khandva M P 2. BhartKumar Vasudeo Goswami Age 28 Khandva M P
Name of The Hospital to which he/she was removed Cottege Hostpital Tal Shirpur Dist Dhule Maharashtra
Number of vehicle and type of the vehicle To vihicle 1. Pikup MP-12-GA-0497 2. Track HMV-MH-18-AA-4991
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. Accused memaly 1. rijvan S/o Abdul Hamid Add vill sendhwa dist-Badwani MP 2. RTO- Badwani MP 3. Licence no MP46R20150089943 valid till TR-23.11.2018 NTR- 23.11.2035
Name of the owner of the vehicle as it stand on the date of the accident MO. Akram Mansuri SO vali MO. Mansuri Add- Kumbar tak Shirpur Dist-dhule Maharashtra
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. New India Assurence co.lid. Add- Hadakhed Tal shirpur Dist Dhule Maharashtra
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 71070031170100010257 vali.till 30.07.2018
Action Taken if any, and the result thereof. -------------
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