Accident Detail Receipt
Date And Time 12-Mar-2018 / 5:30 am
Place of Accident TARDI POLICE CHOWKI ABOUT 1 K.M.DISTANCE IN SHIRPUR CHOPADA ROAD
CR NO/ TAR No/ SDE NO 11/2018
Name of the Injured/ Deceased INJURED NAME - FIROJKHAN ABDHARKHAN PATHAN AGE 65 YEARS AT POST SHAHADA DIST NANDURBAR DEATH NAME - FARDDINKHAN FIROJKHAN PATHAN AGE 23 YEARS AT POST SHAHADA DIST NANURBAR
Name of The Hospital to which he/she was removed 1) COTTEGE HOSPITAL SHIRPUR 2) CIVIL HOSPITAL DHULE
Number of vehicle and type of the vehicle TRUCK MH 18 M 6072 TRUCK GJ 03 W 8672
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. 1) FIROJKHAN ABDHARKHAN PATHAN ISSUNG (ATHOURITY IN RTO DHULE) 2) JAMAL AHEMAD MOHMOD SALIMUDDIN MOH PAHALWARA NEAR DR S.P.YADAV HOUSE NAGAR KOTWALI BALRAMPUR (ISSIUNG ATHORITY IN RTO BALAMPUR
Name of the owner of the vehicle as it stand on the date of the accident 1) FIROJKHAN ABDHAKHAN PATHN AT POST SHAHADA DIST NANDURBAR 2) JILUBHAI B SINDHAV SAHKAR SOCIETY SRTEET NO 6 YASHDEEP NR HASANWADI DIST ROJKOT,GUJRAT
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. 1) UNITED INSURANCE COMPANY POLICY NUMBER 2310013117P117527433 DATE 09/03/2018 TO 09/03/2019 2) RELANCE GENRAL INSURANCE COMPAY POLICY NUMBER 160421723340019349 DATE 03/12/2017 TO 03/12/2018
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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