Accident Detail Receipt
Date And Time 12-May-2017 / 5:30 am
Place of Accident Pankheda shivarat chaure petrolpamp gatirodhak javal
CR NO/ TAR No/ SDE NO 118/2017 ipc 279,337,427 mv act184
Name of the Injured/ Deceased Lilabai revaji mavchi age 30 add parsaripada tal sakri zilha dhule
Name of The Hospital to which he/she was removed Gramin rugnalay pimpalner yethun adhik upcharasathi dhule yethe refar
Number of vehicle and type of the vehicle Doshi vahan-tata crusar MH 18 BC 1925
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. --
Name of the owner of the vehicle as it stand on the date of the accident --
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. --
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate --
Action Taken if any, and the result thereof. Pimpalner PS Cr no 118 ipc 279,337,427,MV act 184

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