Accident Detail Receipt
Date And Time 24-Apr-2018 / 1:30 pm
Place of Accident NH - 06 BAFNA CEMENT GODAON ON THE ROAD LEADING TO DHULE TO PAROLA ROAD
CR NO/ TAR No/ SDE NO DHULE TALUKA CR NO - 121/2018 IPC 304-A.279.337.338.427 SDE NO-23
Name of the Injured/ Deceased 1.PREMCHAND HANSRAJ CHAVAN - DEAD 2.ARVIND PREMCHAND CHAVAN - DEAD 3.KAUSALABAI PREMCHAND CHAVAN 4.VIDYABAI PREMCHAND CHAVAN
Name of The Hospital to which he/she was removed CIVIL HOSPITAL DHULE
Number of vehicle and type of the vehicle 1.MP-46-MH-6572 2.MH-43-Y-5115
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 --
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. REG NO - 121/2018

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