Accident Detail Receipt
Date And Time 27-Jan-2018 / 3:33 pm
Place of Accident Sayane Area,Sarwad-to Lamkani Road Near sayane phata distance from songir police station g km Western side
CR NO/ TAR No/ SDE NO 22/2018 IPS 304(A),279,337,338,427,MVACT 184,134/177,66/192
Name of the Injured/ Deceased Death- Ratilal Dagadu Deware age-18 At post mahalsarwaddha tal shindakheda dist dhule 1) Injured -Ushabhai Dagadu Deware age-38 2)Vimalbhai jibhao bhil age-36 3) Saralabhai jibhao bhil age-15 4) Tadu Raju Bhil age-15 5) Sagar Raju bhil age-13 6) Chintu Jit bhil age-4 AT post mahalsarwaddha tal shindkheda dist dhule 7) Ankush Dagadu Deware age-16 At post lamkani tal dist dhule
Name of The Hospital to which he/she was removed Rural Hospital Songir tal dist dhule
Number of vehicle and type of the vehicle Aperishksha MH-18 AJ 0781
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. Mahendra Tukaram Gawade age-35 AT Post Sarwad tal dist dhule APerishksha MH-18 AJ 0781
Name of the owner of the vehicle as it stand on the date of the accident mahendra Tukaram Gawade age- AT Post Sarwad tal 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. CRPC-41(A) Notice issued

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