Accident Detail Receipt
Date And Time 11-Dec-2017 / 10:00 am
Place of Accident Mumbai Agra National Higway No.03, Opp.Police Higway Tap, Dhule.
CR NO/ TAR No/ SDE NO Cr.No.85/2017 IPC-279,337,427, M.V. Act-184 SDE No.17/15.00
Name of the Injured/ Deceased 1.Suresh Thakaji Thorat, Age-65, Add-Shivajinagar, galli no.01, Dhule. 2.Parshuram Fakira Deokar, 3.Kailas Bandu Deokar, Add-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 Container No.GJ.12 BY 2535
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. Aslam Rojdar Khan, Age-40, Add-Narla Tq-Dhadi, Dist Bharatpur, State-Rajastan.
Name of the owner of the vehicle as it stand on the date of the accident Malik Logistic, A2,26 Block-A2, Jail Road, West Delhi, Janakpuri. 110058.
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-17-1102-1803-00003358
Action Taken if any, and the result thereof. NPC/160 P.B. Nandale

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