Accident Detail Receipt
Date And Time 10-Sep-2017 / 9:30 am
Place of Accident Kharde Patharde Place T- Point Shirpur to Shindkheda road Sauth Sait Shirpur Dist.dhule
CR NO/ TAR No/ SDE NO Shirpur PS CR NO-296/2017 IPC- 304A,279,337,338,427 M V Act.184,134/177
Name of the Injured/ Deceased Bapu Shamrao bhil Age-34 Add -varzadi Tal .shirpur A/p. Kharde Tal Shirpur
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur Dist. dhule
Number of vehicle and type of the vehicle M/C Hoda Shain MH-18-BF-5109
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. Sagar Gawali s/o laxman Add- vikhe nagar chitod road dhule dist.dhule RTO-Dhule L NO- MH-18-20130005488 Valid-14/03/2033 NT
Name of the owner of the vehicle as it stand on the date of the accident 1.Bhatu Narayan maharnurkar Add hatkar Wadi chitor road dhule maharashtra Drive. m/c. Sagar gawli s/o laxman add-vikhe nagr chitod road dhule dist-dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. ICICI Lombard motor insurance Add-414,ICICILgmard house veer savarkar Marg near siddhi vinayak temple main gate prabhadevi mumbai-400025
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 3005/2010794454/00/0000010600 valid-17/08/2017 to 16/08/2018
Action Taken if any, and the result thereof. conversation
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