Accident Detail Receipt
Date And Time 05-Feb-2018 / 11:00 pm
Place of Accident Mumbai Agra National Highway No.03, Opp.New Nalanda, Dhule.
CR NO/ TAR No/ SDE NO Cr.No.13/2018 IPC-279,337,338,427, M.V.Act 184 SDR No.08/03.59
Name of the Injured/ Deceased 1.Raju Sattelal Bagdi, 2. Chetan Nemichand Chordiya, 3.Bablu Gangaram Barodh, 4.Vijay Ramdayal Patel add-Opp.BCI Kalab, Nagta Tes, Tq-Khachor, Dist-ujjain State-MP.
Name of The Hospital to which he/she was removed Hire Medical Collage, Civil Hospital, Dhule.
Number of vehicle and type of the vehicle 1.Cruzer no.MP.09 FA 5697 2.Truck No.MH.18 M 1419
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. Shaikh Rafiq Shaikh Khalil Add-Haji Lukman Nagar, Deopur Dhule.
Name of the owner of the vehicle as it stand on the date of the accident Shaikh Khalil Shaikh Kadar, Add-Haji Lukman Nagar, Deopur Dhule.
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. Bajaj Allianz
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate OG-18-3254-1831-00000087
Action Taken if any, and the result thereof. ASI/V.C. More

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