Accident Detail Receipt
Date And Time 09-May-2017 / 1:30 pm
Place of Accident N H-NO-03 Mumbai Agra highway Near Shirpur Gold Factory Shirpur Dist-dhule
CR NO/ TAR No/ SDE NO shirpur ps cr no-154/2017 IPC-279,337,427 M V Act-184,134/177
Name of the Injured/ Deceased 1-Trulok Jivandas Tyagi Age-47 Add-4-Ashika Gardon Raysen Road Bhopal MP
Name of The Hospital to which he/she was removed Rati hospital shirpur Dist.-dhule(MS)
Number of vehicle and type of the vehicle Two cehicle 1-Swip Dizalar MP-04-CJ-1607 non
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. An non
Name of the owner of the vehicle as it stand on the date of the accident An non
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. An non
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate An non
Action Taken if any, and the result thereof. A Final
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