Accident Detail Receipt
Date And Time 02-Mar-2017 / 11:30 am
Place of Accident Malegaon Road, Avdhan Gaon road, Near Volkswagen Showroom
CR NO/ TAR No/ SDE NO Cr.No.08/2017 IPC-279,337,427, M.V.Act 184, 134/177 SDE No.43/22.10
Name of the Injured/ Deceased Iftekar / Sharukh Ajaj Ansari Age-20, Add-Haji Nagar Dhule.
Name of The Hospital to which he/she was removed Rajesh Patil Hospital, Dhule.
Number of vehicle and type of the vehicle 1.Volkswagen Car No.MH.14 DN 3517 2.Motar Cycle Suzuki Hayate No.MH.18 BB 2770
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. Pramod Narayan Shukla Age-48, add-Narayan mali Chal Station Road Dhule
Name of the owner of the vehicle as it stand on the date of the accident Santosh Dwarkadas Agrawal Add-Walabhnagar, 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. PSI/ K.G.Tadvi

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