Accident Detail Receipt
Date And Time 05-May-2017 / 5:30 am
Place of Accident sarvad near tolnaka songir MH-3 Dhule
CR NO/ TAR No/ SDE NO 24/2017
Name of the Injured/ Deceased Pankaj pradip Bagul age-26 address- Akashy coloney walvadi shivar dhule
Name of The Hospital to which he/she was removed songir goverment hospital songir
Number of vehicle and type of the vehicle 1) Eishar no. MP13-GA 5191 2)Alto no.MH19 AJ5495
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. Eishar no.MP 13 GA 5191 varil driver
Name of the owner of the vehicle as it stand on the date of the accident pankaj bagul
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. sujuki
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate sujuki
Action Taken if any, and the result thereof. Injured person take and go to hospital

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