Accident Detail Receipt
Date And Time 12-Dec-2017 / 5:30 am
Place of Accident Mumbai Agra National Highway No.03, Opp. Baba Tyre, Dhule.
CR NO/ TAR No/ SDE NO Cr.No.87/2017 IPC-279,337, M.V.Act-184 SDE No.22/21.15
Name of the Injured/ Deceased Salim Khan Gukab Khan Pathan Age-43, Add-Firdos 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 Tata 1109 Truck No. GJ.12 AY 5225
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. Anupdan Khetdan Charan Age-55, add-Matoda, Tq-Osiya, Dist-Jodhpur, State-Rajastan.
Name of the owner of the vehicle as it stand on the date of the accident Anupdan Khetdan Charan Age-55, add-Matoda, Tq-Osiya, Dist-Jodhpur, State-Rajastan.
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/ L.V. Pandharkar

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