Accident Detail Receipt
Date And Time 04-Jan-2018 / 5:30 am
Place of Accident Kapadne Area Mumbai Agra National Highway 03 Kadane Phata speed breaker distance from songir police station 8 K.m.
CR NO/ TAR No/ SDE NO 4/2018 IPC 304(A),279,427,337, MVACT 184
Name of the Injured/ Deceased Ashoksing Mohansing Indoliya age 44 At Abhedpura Tal Kirawali dist Agra ( UP)
Name of The Hospital to which he/she was removed Government Medical college Dhule
Number of vehicle and type of the vehicle 1) S.T.BUS MH-18 BT 2107 2) Eichar no MP 11 TRAF 5771
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. 1) Mehendra dilip suryawashi At Nimdale dist dhule public service,number of bage 46, RTO Dhule 2) Ashoksing Mohansing Indyaliya At Abhedo pura post kirawali Dist Agra RTO Agra
Name of the owner of the vehicle as it stand on the date of the accident 1) Govenment Vehicle S.T.Bus Maharashtra 1) Marketing HQ & Works for VE Commercial Vehicles LTD 102 Industial Area NO 1 Pithampur Dist Dhar (MP)
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. 1) Govenment Vehicle 2) ICIC LOMBARD GENERAL INSURANCE CO.Bhobal
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1)--2) police No 3006/000184/04 and Cert.no 3006/000184/04/541878/1
Action Taken if any, and the result thereof. Case Register in songir police station Abet Final 1/2018 Date 9/03/2018

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