Accident Detail Receipt
Date And Time 19-May-2017 / 1:30 am
Place of Accident songir near shivsai hotal javal MH3 RD
CR NO/ TAR No/ SDE NO 41/2017
Name of the Injured/ Deceased Naredra Ghansham devre (Patil) Age -32 address-Pimpalkheda , shinkheda, dhule
Name of The Hospital to which he/she was removed dhule Civil hospital
Number of vehicle and type of the vehicle 1) Hero no.-MH18AT0823 2)Traktar no.-M18N25H94
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. Traktar driver - Youraj Dongar Bhil Age 28 address- songir
Name of the owner of the vehicle as it stand on the date of the accident Youraj Bhil
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Hero company
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Hero company
Action Taken if any, and the result thereof. call 108 Ambulance and injured person goes to civil hospita dhule

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