Accident Detail Receipt
Date And Time 22-Jan-2018 / 10:00 am
Place of Accident Near akkalpaada shivar bridge construction
CR NO/ TAR No/ SDE NO CR NO 12/2018 IPC 304(A),279,337,338,427, r/w MVA 184,183,134,/177,194
Name of the Injured/ Deceased 1) Ganpat mangu chavhan 70 year old at/post:- dagdivihir tal-sakri dist-dhule (Death) 2) Dnyaneshwar popat chavhan 25 year old at/post- dagdivihir tal-sakri dist-dhule
Name of The Hospital to which he/she was removed Rural Hospital Sakri Civil Hospital Dhule
Number of vehicle and type of the vehicle 1) Tankar :- GJ-06-V V-7201 2) Dumpar :- MH-20-CT-1717 3) 407 Tempo:- MH-01-L-4598 4) Moter cycle :- MH-18-EH-9208
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. 1) Mohammad Vasim khan Anawar khan 28 year old at post:- Bindomoh Tal-Navalshahi Dist-Kodram (jharakhad dist) 2) Sanjay ramadas shelara 41 year old at post- Fofare Tal- Dist-Dhule
Name of the owner of the vehicle as it stand on the date of the accident 1) TANKAR :- GJ-06- V V-7201 2) DUMPER :- MH-20-CT-1717
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. TANKAR :- GJ-06-V V-7201 NEW INDIA ASSURANCE CO LTD ADD:- WARDEN HOUSE BUILDING SIR P M ROAD FOR MUMBAI 2) DUMPER :- HM-20-CT-1717 HDF ERGO ADDR:- 165- BOCKBAY RACLAMATION H T PAREKHA MARG CHURCHAGATE MUMBAI
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 02
Action Taken if any, and the result thereof. BOTH ACCUSED WAS ARRESTED DAR FORM FULL AND POST TO HON'BLE COURT

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