|Accident Detail Receipt
| Date And Time
||11-Feb-2018 / 5:00 pm
|Place of Accident
||Shambhar Footy Road, Opp-Mariya High School, Dhule.
|CR NO/ TAR No/ SDE NO
||Cr.No.112/2018 IPC-279,337,338, M.V.Act 184,134/177
|Name of the Injured/ Deceased
||Naeem Shaikh Mushtaq Age-29, Add-Plot No.54, Hajjan Saira High School, Durbal Ghataq So.Dhule
|Name of The Hospital to which he/she was removed
||Rajesh Patil Accident Hospital, Dhule.
|Number of vehicle and type of the vehicle
||1.Motar Cycle No.MH.18 AR 4986
2.Chota hatti No.MH 18 M 5182
|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 Shafi Shaikh Yusuf Age-38, Add-Azandnagar, Near Maruti Mandir, Vadjai Road Dhule.
|Name of the owner of the vehicle as it stand on the date of the accident
||Anwar Shah Ismail Shah Add-Chandtara Chowk Dhule.
|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.