Accident Detail Receipt
Date And Time 27-Apr-2018 / 9:00 am
Place of Accident Place Road Near to Formaci Collage shirpur dist dhule
CR NO/ TAR No/ SDE NO shripur cr no 100.2018 IPC 304A .279.337.338.427 MV ACT -184
Name of the Injured/ Deceased Shubham Shubhash Agrawal Age add- Priteshwar Colony shirpur dist dhule
Name of The Hospital to which he/she was removed cottege Hospital shirpur dist dhule
Number of vehicle and type of the vehicle M/C Bajaj pulser 200 cc MH-18/AT/6410
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. ..
Name of the owner of the vehicle as it stand on the date of the accident .
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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