Accident Detail Receipt
Date And Time 29-Jul-2018 / 3:40 pm
Place of Accident Mumbai Agra National Highway No.03, opp HiGhway Trafic, Dhule.
CR NO/ TAR No/ SDE NO Cr.No.86 IPC-304(A),279,337,338, M.V.Act 184, 134/177 SDE No13/19.05
Name of the Injured/ Deceased Aarish Shabbir Shaikh Age-15, Add-Galli No.1, Dildar Nagar, Dhule.
Name of The Hospital to which he/she was removed Hire Medical Collage, Civil Hospital, Dhule.
Number of vehicle and type of the vehicle Truck No.NL.01 AB 0672
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. Jagan Gamariya Mujalade Age-41, Add-Agalgaon Terajpur, Dist-Badwani, State-MP.
Name of the owner of the vehicle as it stand on the date of the accident Vijay Kedarnath Agrawal Age-47, Add-121, Sundaram Complex, Bhawarpuwa, Dist-Indore, 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/ A.B.Aher

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