Accident Detail Receipt
Date And Time 05-Sep-2017 / 4:30 pm
Place of Accident ON MUMBAI AGRA HIWAY PALASNER NEAR GOAN TAL SHIRPUR DIST DHULE
CR NO/ TAR No/ SDE NO 76/2017IPC
Name of the Injured/ Deceased 304A,279,427,R/W MV ACT 184
Name of The Hospital to which he/she was removed CIVIL (COTEGE) HOSPITAL SHIRPUR
Number of vehicle and type of the vehicle 1) MP-09 HG 8722 2) MP46 M 7662 MOTOR CYCLE
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) AMMICHAND NANURAM BAGHEL AGE 36 ADD- SARAYITLAB TAL &DIST- DHAR (ACUSE) LIC-NO- MP11R-2016-0198389 2) MOHAN FULSINGH BARELA AGE 37 ADD- UMRYAPANI TAL NEWALI DIST BADWANI M.P.
Name of the owner of the vehicle as it stand on the date of the accident 1) GURJIT SHINGH BHATIA ADD- 120 TRANSPORT NAGAR INDORE (ACUSE)
Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance Company. NATIONAL INCURANCE COM, LIT
Number of Insurance Policy/Insurance Certificate and the Date of the validity of the insurance Policy /Insurance Certificate 32170031166300005820
Action Taken if any, and the result thereof. COURT PEANDING
FIR COPY Download Document 1
PANCHNAMA COPY Download Document 2
PM NOTES COPY Download Document 3

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