Accident Detail Receipt
Date And Time 06-Aug-2017 / 2:30 am
Place of Accident Nh3 gurudvara near
CR NO/ TAR No/ SDE NO 86/2017
Name of the Injured/ Deceased Pramod Vijay shinde .. addre . Mohadi tal diet dhule
Name of The Hospital to which he/she was removed Civil hospital dhule
Number of vehicle and type of the vehicle Known veical
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. Unknow parson
Name of the owner of the vehicle as it stand on the date of the accident Unknown Pearson
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Unkownon person
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Unkow veical
Action Taken if any, and the result thereof. A final

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