Accident Detail Receipt
Date And Time 11-Jan-2018 / 7:30 pm
Place of Accident On Dondaicha To Dhule Road Near Hotel Prashant
CR NO/ TAR No/ SDE NO Cr No 05/2018 IPC 304(A), 279]427 Mv Act 184
Name of the Injured/ Deceased Deceased - Namdev Suresh khairnar A/P Umarkhurd Tal , Dist Nandurbar
Name of The Hospital to which he/she was removed Civil Hospital Dondaicha
Number of vehicle and type of the vehicle Deceased - MH 39 P 2423 Hero HF Delux Accused - MH 15 EX 6092 Ford Eco Sport
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. Niranjan Raghunath Mahabal A/P Nashik 5 Suyog Colony Near Bhosla Military School
Name of the owner of the vehicle as it stand on the date of the accident Life Insurance Corporation Of India, Jeevan Prakash Gadkari Chowk Gold Club Ground Old Agra Road Nashik
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. United India Insurance Company Limited, Jeevan Prakash Gadkari Chowk Gold Club Ground Old Agra Road Nashik
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 1606063117P110851298
Action Taken if any, and the result thereof. Accused Produced Before Court Of Dondaicha

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