Accident Detail Receipt
Date And Time 04-Apr-2018 / 8:00 am
Place of Accident SHIRPUR CHOPADA ROAD IN BHATPURA POLICE CHOWKI OF THE FRONT SIDE
CR NO/ TAR No/ SDE NO 17-2018
Name of the Injured/ Deceased INJURED NAME AJAY PRAKASH KOLI AGE 15 YEARS AT POST BHATPURA TAL SHIRPUR DIST DHULE 2) YOGESHWAR SANJAY KOLI AT POST BHATPURA TAL SHIRPUR DIST DHULE
Name of The Hospital to which he/she was removed SATGURU HOSPITAL SHIRPUR AND SEVA HOSPITAL DHULE
Number of vehicle and type of the vehicle 1) MOTAR CYCLE NO NOT RAGISTRATION 2) RUNALT FOURWHEER CAR NO MH 19 CU 5544
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) YOGESHWAR SANJAY KOLI AT JAKHANE TAL DIST DHULE (ISSUING OF AUTHORITY RTO DHULE MH 18 2014120C) 2)JUGUL ASHOKKUMAR GUPTA A/P SARASWATI COLONY SHIRPUR DIST DHULE (SIGNATURE ANS ID OF ISSUING AUTHORITY MH 18 201071C)
Name of the owner of the vehicle as it stand on the date of the accident 2)DIPIKSHA JUGUL GUPATA A/P P.NO 89 MIDC G SECTOR JALGOAN MAHARASHATRA 425405
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. RELIANCE GENARAL INSURANCE COMPANY POLICY PERIOD 17/10/2017 TO 16/10/2018
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 17/10/2017 TO 16/10/2018
Action Taken if any, and the result thereof. CHARGSHEET SUBMIT IN COURT SHIPUR

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