Accident Detail Receipt
Date And Time 01-Jan-2018 / 12:00 pm
Place of Accident Sarwad Area Mumbai Agra National highway 03 Tal Dist Dhule near by songir police station 4 k.m.
CR NO/ TAR No/ SDE NO 1/2018 IPC 304(A),279,338,427, MVACT 184,177/119/134
Name of the Injured/ Deceased 1) Dinesh Nick name Sonya Ramchandra Patil age 28 ( jadhav) (Death) 2) Varsha Kalpesh Patil age 25 ( Death) 3) Shiv nick name Daksha Kalpesh Patil age 2 year - serious injury
Name of The Hospital to which he/she was removed Songir gramin hospital tal dist Dhule
Number of vehicle and type of the vehicle 1) Two Wheeler R.J 36 SM 2656 2) Truck NO MP 09 HH 1472
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. Krishnabhan Bhagarsing age 26 At Khangar Tal Kolaras Dist Shivpuri

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