Accident Detail Receipt
Date And Time 10-May-2017 / 5:30 am
Place of Accident Devbhane shivar NH -3 Alankar Fectory near dhule
CR NO/ TAR No/ SDE NO 107/2017
Name of the Injured/ Deceased 1)Gangubai Choto Bhil 2)Kiran Rajendar Bhil 3)Gokul Barku Bhil 4) Manglabai Prakesh Bhil 5)Chetan Prakesh Mali 6)Kirti Rajendar Bhil 7) Sundarbai sadashiv Mali 8)Apesh barku Bhil 9)Mayabai Barku Bhil 10)Dipali Barku Bhil 11) Rini Barku Bhil 12)Sanjna Barku Bhil 13) Sanjna Barku Bhil 14)Sandip Chotu Bhil 15)Samadhan Chotu Bhil 16)Eshila Shana Bhil 17)Bebabai Shana Bhail 18)Dagubai Shana Bhil 19)Jijabai Julal Bhil all address- Kapadne ,dhule
Name of The Hospital to which he/she was removed songir songir dhule
Number of vehicle and type of the vehicle 1) Traktar no. MH18 AX2631 2)Trola no.MH18 AA9385.
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. 1)Traktar no.MH18 AX2631 2)Trola no.MH18 AA9385
Name of the owner of the vehicle as it stand on the date of the accident Atul Prakesh Mali and Mahadev Ratan Mehta
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Tata company
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate Tata company
Action Taken if any, and the result thereof. Cr no.107/2017 IPC 279,337,338,427 mv act184.
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