Accident Detail Receipt
Date And Time 02-May-2018 / 10:30 am
Place of Accident shirpur to shahada Road Nimzari Naka T point Shirpur dist dhule
CR NO/ TAR No/ SDE NO shirpur cr no 99/2018 IPC 279.337 MV ACT 184.134/177
Name of the Injured/ Deceased Roshan bi Sayyad Haidar Age 60 2. ) Vasim Shaikh Yunush Shaikh Add Mohamdiya Chowk 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 Annon
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. Annon
Name of the owner of the vehicle as it stand on the date of the accident Annon
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. *
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate *
Action Taken if any, and the result thereof. *
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