Accident Detail Receipt
Date And Time 07-May-2018 / 3:00 am
Place of Accident N H -3 Mubai Agra haiway Face to Ekta Hotel shirpur Road tal shirpur dist dhule
CR NO/ TAR No/ SDE NO shirpur cr no 102/2018 IPC 304 A .279.337.338.427 MV ACT 184 .134/177
Name of the Injured/ Deceased laxmi Narayan Shriramlal age add sindhaura derasia dist dhopal MP
Name of The Hospital to which he/she was removed Cottage hospital shirpur dist dhule
Number of vehicle and type of the vehicle Track RJ 17 GA 5576 2. RJ 50 GJ 9729
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. Hetram Mohanram bishnoi age -30 add po-kudsu nokha kaner L NO- RJ 50 20140000801 RTO- DTO NOKHA VALID-22/04/2032
Name of the owner of the vehicle as it stand on the date of the accident Ramswarup mohanram add kudsu nokha bikaner rajeshtan
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. united india company add-
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 2907003117p109576195 25/09/2017 to 24/09/2018
Action Taken if any, and the result thereof. in
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