Accident Detail Receipt
Date And Time 09-Dec-2017 / 7:30 pm
Place of Accident N H NO-3 Mumbai Agra haigway Face to rilaince Petol panp Near to Shirpur Tal plaza Shirpur dist.- dhule (MS)
CR NO/ TAR No/ SDE NO Shirpur ps cr no-349/2017 IPC-304(A),279,337,338, M V Act -184/177
Name of the Injured/ Deceased Chhaya bai Chandrakant Ishi Add-A/P-35/A Sharda Nagar Shirpur Dist-Dhule
Name of The Hospital to which he/she was removed Cottage hospital Shirpur Dist-Dhule
Number of vehicle and type of the vehicle M/C Honda Shain MH-18-AG-2144
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. Chandrakant Kisan Ishi Add-A/P 35/A Sharda Nagar Shirpur Tal Shirpur Dist-Dhule R T O -Dhule D L No- MH18 20060003631 Valid-19-05-2016
Name of the owner of the vehicle as it stand on the date of the accident Chandrakant Kisan Ishi
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Oriontal Insurance Com Add-first floor pushpanjali Market opp manohar chirta mandir agra road near S B I Dhule maharashrta 424001
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 18200/31/2018/522 30/04/2017 to 29/04/2018
Action Taken if any, and the result thereof. Haring

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