Accident Detail Receipt
Date And Time 02-Nov-2017 / 3:00 am
Place of Accident NEAR MALICH CHAWKI,GORANE FATA ON NH 03, TAL SHINDKHEDA DIST-DHULE
CR NO/ TAR No/ SDE NO CR NO. 89/2017 IPC 304 (A),279,337,338,427 MV ACT- 134/177
Name of the Injured/ Deceased DECEASED- KAILAS BABAN CHAUDARI 35, AT- SHIRPUR
Name of The Hospital to which he/she was removed NIL
Number of vehicle and type of the vehicle EICHER /CAR 1.MP 09/ GG 7173 2.MH 18/AJ 7718
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. MOHAMMAD SALMAN MOH. RAFIK 24, AT- MAHU, INDOR MP
Name of the owner of the vehicle as it stand on the date of the accident NIL
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. NIL
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate NIL
Action Taken if any, and the result thereof. CHARGESHEET SUBMITTED IN JMFC, SHINDKHEDA

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