Accident Detail Receipt
Date And Time 26-Dec-2017 / 3:30 pm
Place of Accident NATIONAL HIGHWAY NO 06 SHEVALI FATA
CR NO/ TAR No/ SDE NO 152/2017 IPC 304(A), 279, 337, 338, 427 MVA 184,134/177
Name of the Injured/ Deceased NARAYAN MURYA BHIL 50 YEAR OLD AT POST - HATT MOHIDA TAL- SHAHADA DIST-NANDURABAR (DEATH) MAHADU BUDHA BHIL 55 YEARS OLD AT POST - JUNE MOHIDA TAL- DIST-NANDURABAR
Name of The Hospital to which he/she was removed CIVIL HOSPITAL DHULE CIVIL HOSPITAL NANDURABAR
Number of vehicle and type of the vehicle 1) NL-01-L-1772 2) MJV-6790
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. NL-01-L-1772 PAPU SHAH SHAKIR SHAH AT POST PARABHINDA BAJARA TAL DIST DEVRIYA (UP)
Name of the owner of the vehicle as it stand on the date of the accident NL-01-L-1772 OWNER NAME :- JIWAN ROADLINE ATA POST CHANDMARINAGALAND KOHIMA OFFICE ADDRESS ;- NERULA MIDC NEAR J M SKODA SERVICE STATION SANPADA NAVI MUMBAI
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. NL-01-L-1772 NEW INDIA ASSURANCE CO LTD THANE DO 170100 B/201 PINAK GALAXY OPP-BIG BAZAAR KAPURABAWADI JUNCATION MAJIWADE THANE (W) MAHARASHATRA
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1 DATE OF PERIOD INSURANCE 17/09/2017 PERIOD OF INSURANCE 16/09/208
Action Taken if any, and the result thereof. DAR FROM FULFILL AND SEND TO HON'BLE COURT
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