Accident Detail Receipt
Date And Time 14-Nov-2017 / 6:30 pm
Place of Accident NH-NO-3 Mumbai Indor haiway road shirpur to ajade village please shahada Get flying flyover pol noDPTL/HW/ELB/P107 shirpur dist dhule
CR NO/ TAR No/ SDE NO shirpur PS IPC 304A,279,337,338, MV Act.-184,134/177
Name of the Injured/ Deceased Mohammad Faruk jabir ansari age.20 add- daraipatty tal minapur dist mujjafarpur bihar RTO- NILL L.NO. NILL VALIDI- NILL
Name of The Hospital to which he/she was removed sub distric hospital shirpur dist dhule maharashtra
Number of vehicle and type of the vehicle MH-18-D-4522
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. Mo.faruk jabir ansari age20 add-daripatty tal minapur dist mujjafarpur bihar
Name of the owner of the vehicle as it stand on the date of the accident Mo.Imamoddin lohar add-khetiya road shahada dist nundurbar a/post.ganesh colony 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. NILL
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate NILL
Action Taken if any, and the result thereof. Abet
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