Accident Detail Receipt
Date And Time 11-May-2017 / 12:30 am
Place of Accident songir near dodaicha road hotel dhanshree
CR NO/ TAR No/ SDE NO 34/2017
Name of the Injured/ Deceased Nur Mohamd Rafik Patel Age-36 address- jamcha mala sultan nagar chalisgav rd dhule
Name of The Hospital to which he/she was removed songir gov.hospital songir
Number of vehicle and type of the vehicle 1) scorpio no.MH19 AX 3362 2) Truck no.HR56 L1795
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. Tata motors
Name of the owner of the vehicle as it stand on the date of the accident Nur Mohamd Rafik patel
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Tata motors
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Tata Motors
Action Taken if any, and the result thereof. injured persong take and go to hospital

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