Accident Detail Receipt
Date And Time 04-Jan-2018 / 4:30 pm
Place of Accident Agrawal Nagar, Near Bharat Nursury, Dhule.
CR NO/ TAR No/ SDE NO IPC-279,337,338,427, M.V.Act-184,134/177 SDE No.11/12.59
Name of the Injured/ Deceased Deepali Prashant Deore Age-34, Add-Plot No.151/3Agrawal Nagar, Near Bharat Nursury, Dhule.
Name of The Hospital to which he/she was removed Aasta Hospital, Dhule.
Number of vehicle and type of the vehicle -----
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. HC/12 B.H. Patil

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