Accident Detail Receipt
Date And Time 21-Mar-1917 / 8:00 pm
Place of Accident Waghadi to Boradi Road face to Krushna Natthu Mali his Farmasi Mail Ston no.Shirpur 8K.M. AND Boradi 15K.M. Road Shirpur dist.dhule
CR NO/ TAR No/ SDE NO shirpur ps cr no-96/2017 IPC-304 A,279,338,427, M C Act.-184/177
Name of the Injured/ Deceased Pradip Luka pavra age-30 Add - New Boradi Tal shirpur Dist.Dhule (death) A/P Nakul Sosaity plot no 26 p-4 shirpur dist.dhule
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur and Civil Hospital dhule
Number of vehicle and type of the vehicle M/C MH-15/AH/4858
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. Pradip Luka pavra age-30 add Boradi tal shirpur dist. dhule RTO- D L NO- Valid-
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. A bit

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