Accident Detail Receipt
Date And Time 19-Oct-2017 / 2:00 am
Place of Accident Near Chalisgaon Road Chowfully, mumbai Agra National Highway no.03, Inside Bridge, Dhule.
CR NO/ TAR No/ SDE NO Cr.No.68/2017 IPC-304(A),279,337,338, M.V.Act 184/177 SDE No.20/13.30
Name of the Injured/ Deceased Abhimaniyu Patil Age-60, Add-Plot No.37, Datt Nagar, Mohadiupnagar, 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 Tata 1109 Truck No.MH.18 AA 7389
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. ------------
Name of the owner of the vehicle as it stand on the date of the accident ---------------
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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