Accident Detail Receipt
Date And Time 05-Mar-2018 / 8:30 am
Place of Accident Shirpur to Shahada Road Arthe Village near
CR NO/ TAR No/ SDE NO Shirpur PS-cr no 56/2018 IPC 304A ,279,337,338, MV Act.184,134/177
Name of the Injured/ Deceased 1.Manoj Vasant Mali Age-28 2.Ramchnadra Rajaram Mali Age -11
Name of The Hospital to which he/she was removed Cottage Hospital shirpur dist. Dhule Maharashtra
Number of vehicle and type of the vehicle 1.HMV-Track- GJ-01-AU-4926 2.M/C.-MH-19-T2373
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.Rashikbhai Ganesh bhai Prajapti Age-51 Add-42 Shriram Ro House of ajay Tenament 4 face Rabri Collony Amrewadi Ahamdabad Gujrat 2. RTO- Ahamdabad 3.L No.-GJ-01-19980007843 19/02/2023
Name of the owner of the vehicle as it stand on the date of the accident Rashik bhai Ganesh Bhai Prajapti Add- rabri collony Amrewadi Ahamdabad Gujarat
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 ahamdabad
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 300100311710002811 28/01/2018 to 27/01/2019
Action Taken if any, and the result thereof. -

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