Accident Detail Receipt
Date And Time 20-Apr-2017 / 3:00 pm
Place of Accident pimaplner samoda road -opp bhoe petrol pump streat road
CR NO/ TAR No/ SDE NO 28/2017 IPC act -279]337]338]427 MV ACT 184 etc
Name of the Injured/ Deceased injured-manoj ramchandra patil age -41 bussiness draiwing add-dusane TAL SAKRI DIST DHULE STAY IN GOVARDHAN NAGAR -2 DINDOLI ROAD UDHANA TAL DIST SURAT
Name of The Hospital to which he/she was removed PHC PIMPALNER
Number of vehicle and type of the vehicle TATA COM 1109 VEHICLE NO MH -18-AA-4449 INJURED NAME -MANAOJ RAMCHANDRA PATIL ADD SAME HEAR 2ND VEHICAL NO-NL-01-Q-5917
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. MANOJ RAMCHANDRA PATTIL GE -41 BUSSINESS -DRAIWAR ADD-DUSANE SAKRI NOW LEAVE IN -GOVARDHAN NAGAR -2 DINDOLI ROAD TAL DIST -SURAT LICENSE NO MH -18 20090010298 RTO -DHULEE VALID DATE 04/08/2026
Name of the owner of the vehicle as it stand on the date of the accident NO
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. NEW INDIA INSURANCE COMPANY LIMITED CHALISGAON SHAKHA INSURANCE POLICY NO -16070231160100004790 VALID DATE 22/3/2017 TO 21/3/2018
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate VALID DATE 22/3/2017 TO 21/3/2018
Action Taken if any, and the result thereof. MANOJ RAMCHANDRA PATIL AGE -41 BUSS-DRAIWAR ADD -DUSANE TAL SAKRI DIST DHULE NOW LEAVE IN GOVARDHAN NAGAR 2 DINDOLI ROAD UDHNA TAL DIST -SURAT HIS ARREST ON DATED 27/6/2017 -12.45 -AND HES SATND ON THE JMFC COURT SAKRI -CUSTADI N REMAND

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