Accident Detail Receipt
Date And Time 13-Aug-2017 / 2:00 pm
Place of Accident vasa to waghadi raod shirpur dist.dhule maharashtra
CR NO/ TAR No/ SDE NO shirpur ps cr no. 252/2017 IPC 304A ,279,337,338,MV Act-184,134/177
Name of the Injured/ Deceased Rakesh Suresh pawra age-25 add- manjani pada tal shirpur dhule
Name of The Hospital to which he/she was removed Sub district hospital shirpur dist dhule maharashtra
Number of vehicle and type of the vehicle LMV- MH-06-AG-3910 pikup ace
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. vijay vishnu Bachalkar Add- chittod Village Tal dhule dist.dhule maharashtra RTO- Dhule LNo.MH-18-20130007292 Vilidi-04/04/2033
Name of the owner of the vehicle as it stand on the date of the accident Shaikh Jakir Shaikh Allauddin Add- 40gaon road Hudko 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. chola.M S General Insurance company ltd.dara house 2nd floor no-2 NSC Bose road chennai
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 3379/0122751/000/00 16/5/17 to15/05/2018
Action Taken if any, and the result thereof. -

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