Accident Detail Receipt
Date And Time 26-Oct-2017 / 7:00 am
Place of Accident Vadi Vagadi Road Kuche Fata Tal shirpur Dist.Dhule Maharashtra
CR NO/ TAR No/ SDE NO shirpur PS CR NO-318/2017 IPC 297,337,338,427
Name of the Injured/ Deceased Imran Majid Manyar age-19 add - Vadi
Name of The Hospital to which he/she was removed Cottage Hospital shirpur and Sidhdeshwar Hospital Dhule
Number of vehicle and type of the vehicle Kali pili MH-18-E-8350 Mahendra
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.(Sonya) Harichand Nimba patil Add-vadi tal shirpur 2. RTO- Dhule 3. L NO-MH-18-20071004083 4.Vilidi.01/02/2017
Name of the owner of the vehicle as it stand on the date of the accident Harichad (Sonya) Nimba Patil Add - vadi tal-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. Bajaj alaince
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate OG-18-2002-1831-00000-173 18JUN.2018 00.00 PM
Action Taken if any, and the result thereof. haring

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