Accident Detail Receipt
Date And Time 25-Jun-2018 / 1:30 am
Place of Accident shahada to shirpur road near by shingave village karmvir petrol pump frunt
CR NO/ TAR No/ SDE NO shirpur ps cr no 149/2018 ipc 279,427 m v act 184
Name of the Injured/ Deceased gaffarbhai ahemadbhai sama age 32 add. hatfodi tal upleta dist rajkot state gujarat
Name of The Hospital to which he/she was removed ..
Number of vehicle and type of the vehicle GJ 03 VV 5311 TATA prima
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. gaffarbhai ahemadbhai sama age 32 add. hatfodi tal upleta dist rajkot state gujarat RTO RAJKOT Lic.no. GJ0220110003161 valid. 10/04/2021
Name of the owner of the vehicle as it stand on the date of the accident kisan emplosives agency add. moti bazar darbar chowk gondal dist rajkot state GJ
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. The oriental insurance company ltd rajkot
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 143000/31/2018/8252 14/12/2017 to 13/12/2018
Action Taken if any, and the result thereof. investigation proceed

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