Accident Detail Receipt
Date And Time 02-Jan-2018 / 5:30 pm
Place of Accident Varkhedei Road, Old Dhule.
CR NO/ TAR No/ SDE NO CR No.03/2018
Name of the Injured/ Deceased Bhausabeb Yashvanat Patil Age-44 Add- Varkhedi Road, Dhule.
Name of The Hospital to which he/she was removed Patil Accident Hospital Dhule.
Number of vehicle and type of the vehicle MH 18 AR 2658 (Bike) Swift Desire Car No-MH 04 GD 1420
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. Kishore Gopal Fulpagare Age-30 Add. Galli No-13 Bhoi Galli Old Dhule.
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. CR No-03/2018 STC No-469/2018 Court Pending

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