Accident Detail Receipt
Date And Time 27-Nov-2017 / 7:30 am
Place of Accident Savalde village Shinkheda road HW-3 Shinkheda road 100 fut. accident place
CR NO/ TAR No/ SDE NO Shirpur PS cr no-338/2017 IPC -304A ,279,337,338 M V Act-184,134/177
Name of the Injured/ Deceased Mirabai Uttam Koli Add-Navaplot Shinkheda Road Savalde tal shirpur Dist.dhule
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur Dist. dhule
Number of vehicle and type of the vehicle Hay dra Kren MH-18-Z-4043
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. Anil Solanki S/o Kamal sing Add- Vill Pithampur dist.-Dhar MP RTO- Dhar L NO- MP11R-2016-0058606 Valid-04/04/2019 TR 04/04/2036 NTR
Name of the owner of the vehicle as it stand on the date of the accident Prabhakar Sitaram Patil Add-Bhagwant park worzodi Toad shirpur dist dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. The Oriental insurance company limited add-first floor sushpanjali market opp manohar chitra mandir agra road near SBI Dhule 424001 (MS)
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 182600/31/2017/5782 Valid-25/01/2017 to 24/01/25018
Action Taken if any, and the result thereof. conversation
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