Accident Detail Receipt
Date And Time 30-Dec-2017 / 12:30 pm
Place of Accident NH - 211 Dhule to chalisgaon road between junvane to bhorvihir phata
CR NO/ TAR No/ SDE NO CR NO - 382/2017 SDE NO - 20 IPC 279.337
Name of the Injured/ Deceased 1.Shamkat prakash bhadane
Name of The Hospital to which he/she was removed Astha hospital dhule
Number of vehicle and type of the vehicle 1.M/Y NO - MH-18-AE - 1859 2.CAR NO - MP-09-CQ-8376
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. CAR NO -MP-09-CQ-8376
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 -382/2017

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