Accident Detail Receipt
Date And Time 06-Apr-2017 / 4:00 am
Place of Accident NH-3- Kurkhali T Point shirpur Tal shirpur dist.dhule
CR NO/ TAR No/ SDE NO Shirpur PS -CR NO-187/2017 PIC 279,337,338 MC Act-184/177
Name of the Injured/ Deceased Pravin mahadoe Gode age-33 add-Nathachi vadi Tal Dhoud dist.pune
Name of The Hospital to which he/she was removed Cottage hospital Shirpur dist.dhule
Number of vehicle and type of the vehicle lGV BOLERO pikap MH-12-LT-9008
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. Pravin mahadeo Gode Age -33 Nathachi vadi Tal.-dhoud Dist.pune RTO- nill l no- nill vilidy- nill
Name of the owner of the vehicle as it stand on the date of the accident Appa Bapu Gore Add- sortapwadi Tal haveli 412110 maharashtra
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. kundan global insurance marketing lip
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 20134003011510020910000 / 01567079500 02/02/2017 to 01/02/2018
Action Taken if any, and the result thereof. A bet
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