Accident Detail Receipt
Date And Time 02-Feb-2018 / 11:40 am
Place of Accident Shahada to Chopada road Shirpur village Mandal shiwar Taun Holl face shirpur
CR NO/ TAR No/ SDE NO shirpur PS CR NO-27/2018 IPC 304A, 279,337,338, MV ACT.184,
Name of the Injured/ Deceased Jijabrao Pandit Patil 60 age add Tardi Tal shirpur at.post.Gayattri Nagar shirpur
Name of The Hospital to which he/she was removed sub dist.Hospital shirpur dist dhule
Number of vehicle and type of the vehicle Two vehicle 1. HMV Track CG-04-LQ-8105 2. M/C MH-18-AK-6795
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. Subodh dular sharma 25 Age add. Pavar house raod lont sait rahul killa dist sundargad orisa state. 2. L.NO- OR1420090096885 3.RTO-Rourkela 4.Valid 29.12.2029
Name of the owner of the vehicle as it stand on the date of the accident Mordhavj Modirka Yadav Add-ch.2265 slice-03 veersawarkar Nager Hirapur Raipur
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Cholamanbalam M S General Insurance company ltd. Dara house 2nd Florr no2 NSC Bose road shennai 600001 INDIA
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 3379/01052444/000/00 27/02/2017 TO26.02.2018
Action Taken if any, and the result thereof. .
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