Accident Detail Receipt
Date And Time 06-Jan-2018 / 5:00 pm
Place of Accident Vergon to lamkani road
CR NO/ TAR No/ SDE NO 38/2018 Ipc 304(a),279.
Name of the Injured/ Deceased Sattu bhaurow malche age 50 at vergon tal sakhri dist dhule
Name of The Hospital to which he/she was removed Civil hospitaal dhule
Number of vehicle and type of the vehicle 1) swift dizair car dn 09 l 1328 2) atles cycle
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. Mmanokamna savaliya kuwar age 27 at a -10 maheshwari sosyati pimplon surat (gujrat) Li no
Name of the owner of the vehicle as it stand on the date of the accident Durgesh ramnath shing age 34 at room 260 manli reshidenshi cr patil road dindori couhfuli surt (gujrat)
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. ICICI lembard jenral insurens company ltd at icici lembard hous 414 vir savrkar marg near shidivinayk tempal prbhadevi mumbai 400025
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1)Validity of cerificate 10 octombe 2017 to 09 octomber 2018 2)Number of insuration - 1
Action Taken if any, and the result thereof. Police inqury
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