Accident Detail Receipt
Date And Time 12-Nov-2017 / 4:00 pm
Place of Accident Near of Firoj Set Farmasi by Road shirpur to Nimzari Tal shirpur dist.dhule (MS)
CR NO/ TAR No/ SDE NO Shirpur PS cr no-326/2018 IPC-304(A),279,201,427 M V Act-3(1)181,137/177,196
Name of the Injured/ Deceased Deshamukh Ranchhod Chauhan Add Gram Temla Tal -Pansemal Dist-Badwani (MP)
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur Dist-Dhule (MS)
Number of vehicle and type of the vehicle Auto Rishha MH-19-BJ-4063
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. Sudam Mamraj Jadhav Add-Ajnad Tal -shirpur Dist-dhule RTP - NIL D L NO- NIL Valid- nil
Name of the owner of the vehicle as it stand on the date of the accident Sudam Mamraj Jadhav Add Ajanad Tal 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. NIL
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate NIL
Action Taken if any, and the result thereof. Invigation
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