Accident Detail Receipt
Date And Time 11-Mar-2018 / 12:30 am
Place of Accident On National High Way No. 3 near Lauki Fata Tal. Shirpur
CR NO/ TAR No/ SDE NO 18/2018
Name of the Injured/ Deceased Rupsing Gajya Pawra Age-25
Name of The Hospital to which he/she was removed Cottege Hospital Shirpur Dist. Dhule
Number of vehicle and type of the vehicle One Vehicle of Eicher Van Reg. No. MP-09/ GF 2559
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. Moin S/o. Aashik Khan r/o. Lion club anjad dist. Badwani- Accused 2. RTO Badwani 3. Licence N. MP- 46r/2017 008334 valid till 2010
Name of the owner of the vehicle as it stand on the date of the accident Moin Aashik Khan r/o. Lionclub anjad dist. Badwani (MP)
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. National Insurance Company Ltd. Kolkatta Div. Offic. Dhamnod Dist. Dhar (MP)
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 32040431171j0004549
Action Taken if any, and the result thereof. action taken

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