Accident Detail Receipt
Date And Time 06-Oct-2017 / 8:30 pm
Place of Accident NH 06 Near the speed breaker at bhadane village
CR NO/ TAR No/ SDE NO CR NO - 326/2017 SDE NO - 13
Name of the Injured/ Deceased 1.Ballu ashok vende
Name of The Hospital to which he/she was removed Shudha hospital dhule
Number of vehicle and type of the vehicle 1.CAR NO -MH-18-R-1270 2.UNKNOW TRUCK
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 -326/2017

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