Accident Detail Receipt
Date And Time 14-Mar-2018 / 10:00 am
Place of Accident SHIRPUR CHOPADA ROAD AHIYAPUR FORK NEAR
CR NO/ TAR No/ SDE NO 13/2018
Name of the Injured/ Deceased INJURED NAME YOGRAJ BOPALSING RAJPUT AT POST BHORKHEDA TAL SHIRPUR DIST DHULE
Name of The Hospital to which he/she was removed SATGURU HOSPITAL SHIRPUR AND DR.ZENDE HOSPITAL DHULE
Number of vehicle and type of the vehicle MOTAR CYCLE NO MH 18 AT 5855 TATA MAGIC NO MH 18 AJ 0067
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. BRIJESH RAMESH WANI SIGNATURE AND ID OF ISSUING AUTHORITY RTO DHULE
Name of the owner of the vehicle as it stand on the date of the accident ASHOK VASANT SHIRSATH AT ANTURLI POST VARUL TAL SHIRPUR DIST ANTURLI DHULE
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. SHRIRAM CENERAL INSURANCE COMPANY LIMITED E-8 EPIP SITAPURA INDUSTRIAL AREA JAIPUR RAJASTHAN
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate POLICY NO 10003/31/18/083691 DATE 10/05/2017 TO MIDNIGHT OF 09/05/2018
Action Taken if any, and the result thereof. CRIMINAL ARRESTED BY THE COURT SENT

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