Accident Detail Receipt
Date And Time 23-Apr-2017 / 7:30 pm
Place of Accident Chalisgaon Road Chowfully, Dhule.
CR NO/ TAR No/ SDE NO Cr No.21/2017 IPC-304(A),279,337,338,427, M.V.Act 184
Name of the Injured/ Deceased Rohidas Yaswant Patil Age-70, Add-Sudarshan Colony Plot No.28, Near Shaskiya Dhudh Dairy, Dhule.
Name of The Hospital to which he/she was removed Siddeshwar Hospital, Dhule.
Number of vehicle and type of the vehicle 1.Truck No.MP 09 HG 4309 2.Pleasure Motar Cycle No.MH 18 KM 5625
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. Nannu Gandelalsingh Age-35, Add-Surpala Dist-Khargoan State-MP.
Name of the owner of the vehicle as it stand on the date of the accident Nannu Gandelalsingh Age-35, Add-Surpala Dist-Khargoan State-MP.
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. ------
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. PSI/ K.G.Tadvi

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