|Accident Detail Receipt
| Date And Time
||22-May-2018 / 12:00 pm
|Place of Accident
||NATIONAL HIGHWAY NO 6 VILLAGE KAVATHE TAL SAKRI
|CR NO/ TAR No/ SDE NO
||CR NO 64/2018 IPC 304 (A)
|Name of the Injured/ Deceased
||RAMKRUSHAN VASANT SHIRSAGARA AT POST KAVATHE TAL SAKRI DIST DHULE
|Name of The Hospital to which he/she was removed
||SIDDHESHWAR HOSPITAL DHULE
|Number of vehicle and type of the vehicle
|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.
||LALAJIBHAI RAVAJIBHAI RANGAPRA AG 37 AT POT AASHRA NAGARA BABARAA TAL DIST AMRELI GUJARATH
|Name of the owner of the vehicle as it stand on the date of the accident
||LALAJIBHAI RAVAJIBHAI RANGARAPRA AG 37 AT POT AASHRA NAGARA BABARA TAL DIST AMRELI GUJARTH
|Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company.
||RELIANCE GENERAL INSURANCE
AT POST BUSINESS EMPIRE 3RD GLOOR DR RADHAKRUSHNA ROAD NR KATHIYAWAD GYMKHAN YAGNIK ROAD RAJKOT
|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.
||THE CASE WAS PENDING FOR MEDICAL CERTIFICATE AND PM REPORT