Accident Detail Receipt
Date And Time 25-Jun-2018 / 3:00 am
Place of Accident Bhaver Road Near Chorya Nala Road Var
CR NO/ TAR No/ SDE NO 28/2018 STD No 14.1500
Name of the Injured/ Deceased Injured Name Shahrukh Chiraguddin Momin Age 25 Year At.Post Holnantha tal Shirpur Dist Dhule Death Name Shahrukh Ibrahim Pinjari At Post Holnathe Tal Shirpur Dist Dhule
Name of The Hospital to which he/she was removed 1) Cottage Hospital Shirpur Dist Dhule 2) Chopada Hospital
Number of vehicle and type of the vehicle 1) Motar Cycle No MH 18 AR 3184 2) Un Detect Tractor
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 Chiragkodin U Momin At Post Holnantha Tal Shirpur Dist Dhule
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. ---
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. Investigavtion Chalu Ahe

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