Accident Detail Receipt
Date And Time 01-Jan-1970 / 9:30 pm
Place of Accident Shirpur Chopada Road Rajendra Tumadu Rajput His Farme Near
CR NO/ TAR No/ SDE NO CR No 02/2018
Name of the Injured/ Deceased Sachin Sukdev Patil Age 25 At Post Hingona Tal Chopada Dist Jalgoan
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur Dist Dhule
Number of vehicle and type of the vehicle 1) Unkown Vehicle 2)Motar Cycle No MH 19 BB 1476
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. 1) Unkown Vehicle 2)
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. Find For Unkown Vehicle

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