Accident Detail Receipt
Date And Time 28-Apr-2018 / 10:00 am
Place of Accident NH 03 Highway Service Road Parola Choufuly, Dhule.
CR NO/ TAR No/ SDE NO CR No-53/2018
Name of the Injured/ Deceased 1) Shobabai Ganjidhar Bhil Age-45 2) Dnyaneshwar Sattar Bhil Age-34 3) Vandanabai Mangal Bhil Add. Ravane Tal. Shindkheda Dist. Dhule.
Name of The Hospital to which he/she was removed Civil Hospital Dhule.
Number of vehicle and type of the vehicle Truck No- WB 29 AA 3004 Motor Cycle MH 18 Q 6010
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. Nishadkumar Day Nityanandkumar Day Age-30 Add.Kalpanaja Chakbajit Post Debra, Paschim Medinapur, (West Bengol)
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 53/2018 On Investigation

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