Accident Detail Receipt
Date And Time 08-Jul-2017 / 5:30 am
Place of Accident NH-06 Surat Nagpur haywe near akalad village
CR NO/ TAR No/ SDE NO CR NO-214/2017 SED NO - 19
Name of the Injured/ Deceased Bhushn Mali Age - 25
Name of The Hospital to which he/she was removed Civil Hospital Dhule
Number of vehicle and type of the vehicle 1-MH-18-BB-8404 2-MH-40-BG-0679
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. Manusham datta bharti age - 27 / ward no - 3 dist - chandrapur
Name of the owner of the vehicle as it stand on the date of the accident Manusham datta bharti age - 27 / ward no - 3 dist - chandrapur
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. --
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