Accident Detail Receipt
Date And Time 06-Feb-2017 / 7:30 pm
Place of Accident Shahada to Shirpur Road
CR NO/ TAR No/ SDE NO Shirpur PS CR NO-183/2017 IPC-304 A ,279,338, M V Act.184
Name of the Injured/ Deceased 1.Rahul Lakshman Kumavat Add-Bramhangaon Tal Satana Dist.Nashik Maharashtra 2.Digambar Hiraman rajkuvar Add-bramhangaon Tal Satana Dist.Nashik
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur and Shidheshwar hospital Dhule
Number of vehicle and type of the vehicle Toyato -MH-18-AJ-1817 M/C MH-41-AP-8143
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. Padmakar Yograj Patil age-39 Add-subhash colony Plot no 40 Shirpur Dist dhule MS RTO-Dhule L No- MH1820130013744 valid-24/04/2028
Name of the owner of the vehicle as it stand on the date of the accident Padmakar Yograj Patil Add-subhash colony Plot no 40 shirpur dist.dhule MS
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. S BI Ganral Insurance company 101/102/103 Natraj Janshan Vestan haywe Adheri kurla Road mumbai
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate T I T/91467308 valid-11/04/2017 to 10/04/2018
Action Taken if any, and the result thereof. conversation

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