Accident Detail Receipt
Date And Time 13-Sep-2017 / 2:30 pm
Place of Accident NH-06 In front of centrale bank in fhagne village shivar
CR NO/ TAR No/ SDE NO CR NO - 308/2017 SDE NO 27 IPC 279.337
Name of the Injured/ Deceased 1.Abdul gafoor abdul khalak momin
Name of The Hospital to which he/she was removed Civil hospital dhule
Number of vehicle and type of the vehicle M/Y NO MH-19-K-6629 CAR NO MH-19-BJ-5885
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. --
Name of the owner of the vehicle as it stand on the date of the accident --
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. --
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate --
Action Taken if any, and the result thereof. REG NO 308/2017

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