Accident Detail Receipt
Date And Time 16-Jun-2017 / 11:30 am
Place of Accident Mumbai Agra National Highway no.03, Opp. Laxmi Engg.Workshop, Dhule.
CR NO/ TAR No/ SDE NO CR no.44/2017 IPC.279,337,338,427, M.V.Act 184,119/177. SDE NO.34/18.15
Name of the Injured/ Deceased Mahendra Singh Harcharan Singh minn Age-60 Add-9/b Punjabi Colony, Tikhi Road, Mohadi Dhule.
Name of The Hospital to which he/she was removed Seva Hospital, Sakri Road, Dhule
Number of vehicle and type of the vehicle Bajaj Pulsar, MH.18 AT 9941
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. Tushar Ashok Jain Age-18 Manik Nagar, Veer Shivaji Chow Dhule.
Name of the owner of the vehicle as it stand on the date of the accident Tushar Ashok Jain Age-18 Manik Nagar, Veer Shivaji Chow Dhule.
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 LTD.
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 2313003115P112798812 Validity.25/01/2017
Action Taken if any, and the result thereof. ASI/ V.C.MORE

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