Accident Detail Receipt
Date And Time 17-Mar-2018 / 5:00 pm
Place of Accident please shirpur to shahada raod Farmsi collage near bapuji karana dukan tal shirpur dist dhule
CR NO/ TAR No/ SDE NO shirpur cr no 84/2018 IPC 279 .338 .427 MV ACT 184.134/177
Name of the Injured/ Deceased Prabhakar tukarm chavhan age 63 add mali galli shirpur dist dhule
Name of The Hospital to which he/she was removed cottage hospital shirpur and suyog hospital dhule and kokilben dhirubhai ambani hospital mumbai
Number of vehicle and type of the vehicle 1. MH 18 U 8474 2. M H 18 BF 8987
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. Prabhakr tukaram chavhan add mali galli shirpur l no-mh1820100012816 RTO-DHULE VALID-6/10/2020
Name of the owner of the vehicle as it stand on the date of the accident Prabhakar rao Tukaram chavhan add mali galli shirpur dist dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. orientalinsurance org in company first floor pushpanjali market opp manohar chirta mandir agra road near S B I dhule
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 182600/31/2018/4304 29/11/2017 to 28/11/2018
Action Taken if any, and the result thereof. in
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