Accident Detail Receipt
Date And Time 01-Mar-2018 / 8:00 am
Place of Accident S/H NO- 4 shirpur to shahada ,Shahada Road Bhatane village about Petol panp Tal.shirpur dist.dhule (MS)
CR NO/ TAR No/ SDE NO Shirpur PS cr no- 54/2018 IPC- 304 A,279,337,338,247 M V Act.184,134/177
Name of the Injured/ Deceased 1. Parshuram Shamrao koli Age-25 Add-Talhadi Tal -Shirpur Dist.dhule 2. Mangesh Shamrao koli Age- Add-Talhadi Tal -shirpur Dist.Dhule
Name of The Hospital to which he/she was removed Cottage hospital Shirpur Dist.Dhule (MS)
Number of vehicle and type of the vehicle Tack HMV- GJ-03 AT-3731 M/C- MH-18-AS-2651
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. Firoj Karimbjhai paleja Add- vati para Borocha Vas Galli no-02 Rajko (GJ) RTO- Rajkot D L NO- gj03 20020104628 Valid- 10/09/2028 (NT) 18/09/2018 (RT)
Name of the owner of the vehicle as it stand on the date of the accident Motibhai Nagajanbhai Garchar Add-01 Nprocja Spc.Rajkot
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Chola Mandalam MS General Insurance company Add- Rajkot branch office 2nd floor saket plaza Dr.Rajendraprasad Road panchanath plot street no-11 corner nr panchanath mandir rajkot (GJ)
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 3379/01896852/000/00 Valid - 22/12/2017 to 21/12/2018
Action Taken if any, and the result thereof. INVEGATION
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