Accident Detail Receipt
Date And Time 01-Jan-1970 / 8:00 am
Place of Accident DAHIVEL TO PIMPALNER ROAD ROHAN GAON SHIVAR HARSING TIRSINGH BAGUL HER FARM HOUSE ON TURNING POINT
CR NO/ TAR No/ SDE NO CRAIG NO 116/2017 IPC 279,337,,338.,427 ND ACT 184,134/177
Name of the Injured/ Deceased Injured NAME DHARMA BHAURAO SONAVNE
Name of The Hospital to which he/she was removed PHC PIMPALNER AND THEN REFAR TO NIRMAYA HOSPITZL WHILE
Number of vehicle and type of the vehicle CRIMINAL VEHICLE NO TRUCK NO G J 01 D X 5083 INJURED VEHICLE SPLENDER MOTAR CYCLE M H 18 B T 9410
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. TRUCK NO G J 01 D X 5083 N SPLENDER PRO MOTHER CYCLE NO M H 18 B B 9410
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. ICICI LOMBARD MOTAR INSURANCE MUMBAI a dress issue bhondgaon tel Saudi DIST dhule INSURANCE POLICY NO_3005/36439693/10926/000
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate POLICY NO 3005/36439693/10926/000
Action Taken if any, and the result thereof. A rest on 27/11/2017 ipc act 279,337,338,427 MV ACT 184 134/177 Refer court Sakri

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