Accident Detail Receipt
Date And Time 06-Nov-2017 / 7:40 am
Place of Accident VADJAI ROAD, NEAR MICRO TOWER, DHULE.
CR NO/ TAR No/ SDE NO Cr No.77/2017 IPC-279,337,338, M.V.Act 184, 134/177 SDE No.28/17.35
Name of the Injured/ Deceased Sirajuddin Salauddin Qureshi age-18 Add-Kamgarnaga, Near National urdu High School, Dhule.
Name of The Hospital to which he/she was removed Siddeshwar Hospital, Dhule.
Number of vehicle and type of the vehicle 1.Motar Cycle No.MH.18 AY 0251 2.Motar Cycle No.MH.18 AE 0792
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. Jilani Shaikh Yunus Shaikh Age-24, Add-Azadnagar, Near Akbari Masjid, Dhule.
Name of the owner of the vehicle as it stand on the date of the accident Jilani Shaikh Yunus Shaikh Age-24, Add-Azadnagar, Near Akbari Masjid, Dhule.
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. ICICI Lombard
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 3005/AI-11128951/00/000 Validity-26/12/2017
Action Taken if any, and the result thereof. HC/12 B.H.Patil

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