Accident Detail Receipt
Date And Time 14-May-2017 / 5:30 pm
Place of Accident Shahada Road Talhadi village Near Tal.Shirpur Dist Dhule Maharashtra
CR NO/ TAR No/ SDE NO Shirpur PS-cr no- 160/2017 IPC 304A,279,337,338,417, MV ACT-184,134/177
Name of the Injured/ Deceased 1. Akash Dagdu Sawaldekar Age -19 2. Dr.Himanshu Hematkumar Sharma Age- add. Narmda Nagar Lonkheda Tal shahada dist . Nandurbar
Name of The Hospital to which he/she was removed Cottege hospital Shirpur Dist.Dhule Maharashtra
Number of vehicle and type of the vehicle To. Vehicle 1. Motar Cycal MH-18DN-9192 2. EICHAR MH-40Y-2348
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. Accused Namely- Dipnarayan S/o Shamdhar Mishra Age 32 R/O Godhari-Dera-Tal Mahuganj Dist-Riva MP (license add- P NO-46 Swamidham Residency H/O Adapa Road Desa Road Ghogoli) 2. RTO - Nagpur 3. Licence no dlno mh-31-20070025415 vaild till 2019
Name of the owner of the vehicle as it stand on the date of the accident Swapnil Ashok Kumbhare Add-64A Bubey Nagar Raja P Near Rukmini Hall Hadkeshwar road dist. Nagpur
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. National Insurance Company limited Paul Commercial CompleX Ajini Squara Wardha road Nagpur Maharashtra Pun 440015 vaill till
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 281107/31/16/6300003994
Action Taken if any, and the result thereof. .
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