Accident Detail Receipt
Date And Time 01-Jun-2018 / 12:30 am
Place of Accident Shirpur Chopda Road Bhorkheda Gaon Near on Road
CR NO/ TAR No/ SDE NO 27-2018 STE No 11/13.30
Name of the Injured/ Deceased Injured Name Urmila Jagdish Jadhav age 50 At Post Tal Pansemal Dist Badwani 2) Anita Mohan Jadhav age 40 At Post Tal.Pansemal Dist Badwani Death Name 1) Jagdish Tukaram Jadhav At Post.Tal.Pansemal Dist.Badwani 2) Mohan Tukarm jadhav At.Post.Tal.Pansemal Dist Badwani
Name of The Hospital to which he/she was removed Cottage Hospital Shirpur
Number of vehicle and type of the vehicle Sift Company Car No.MH 06AS 4455
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. Jagdish Tukaram Jadhav Draving Licence No MH 1819870002330 issuing Authority MH 18 2015120
Name of the owner of the vehicle as it stand on the date of the accident Nitin Shantaram Lad Sudama Colony Street No 02 Sendwa Dist Badwani (Owner is No Stand in Accident Place)
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Nee India Assurance bldg 87 M.G.Road Fort,Mumbai 400001
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 45170031170200005050 Date 28/12/2017 To 27/12/208 Midnight 11.59.59 PM
Action Taken if any, and the result thereof. ---

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