Accident Detail Receipt
Date And Time 22-May-2018 / 6:30 am
Place of Accident NATIONAL HIGH WAY NO 6 VILLAGE OF KAVATHE TAL SAKRI
CR NO/ TAR No/ SDE NO CR NO 68/2018 IPC 279
Name of the Injured/ Deceased PANKAJ RAVINDRA KOLI AT POST BALAPUR TAL DIST DHULE DNYSHWAR SURESH MISTRY AT POST BALAPUR TAL DIST DHULE
Name of The Hospital to which he/she was removed SIDDHESHWAR HOSPITAL DHULE
Number of vehicle and type of the vehicle MOTER CYCLE NO MH-18BB-9971 PICKUP GJ-19-U-3950
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. DNYANESHWR SURESH MITRARY AT POSTBALAPUR FAKGE TAL DIST DHULE SOOFIYAN ILYAS JADA AT POT NARLI TAL MANGROL SURAT GUJARAT
Name of the owner of the vehicle as it stand on the date of the accident DNYANWSHWAR SURESH MISTRY AT POST BALAPUR TAL DIST DHULE SOOFIYAN ILYAS JADA AT POST NAROLI TAL MANGROL SURAT GUJARAT
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. BAJAJ ALLIANZ GENERAL INSURANCE COMPANY LTD AIRPORT ROAD YERWAD PUNE
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate OG-16-2203-1831-00003243
Action Taken if any, and the result thereof. THE CASE WAS PENDING FOR MEDICAL CERTIFICATE

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