| 1. |
Police Station Name. |
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KOLAD POLICE STATION |
| 2. |
CR No. |
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cr no 32/2018 IPC 304A ,279,337,338, mv act 184,134 |
| 3. |
Accident No. |
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NULL |
| 4. |
Date,Time And Place Of Accident |
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2018-06-22 , 20:00 , At Sutarwadi Kolad Bhira road |
| 5. |
Name of Injured/Deceased |
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Deceased Person Sagar Balaram Raykar |
| 6. |
Name of the Hospital to Which He/She Was Removed |
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SUB DIVISIONAL HOSPITAL ROHA TALUKA ROHA DIST RAIGAD |
| 7. |
Number Of Vehical and type Of the Vehical |
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2 , unknown Vehicle and motor cycle |
| 8 |
Name and Address Of the Driver Of the
Vehical With Particulars Or Driving License
Of the Said Driver And the Address Of
Issuing Autdority Of the Said Driving
License.the Number Of Badge in Case
Of Public Service Vehical and Address of
Issuing Autdority Of the Said Badge |
:- |
unknown |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
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Unknown,unknown |
| 10. |
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company. |
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Null , Null , Null |
| 11. |
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate. |
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Null,0000-00-00 , 0000-00-00 |
| 12. |
Action Taken, If Any, And the Result thereof |
:- |
cr no 32/2018 IPC 304A ,279,337,338, mv act 184,134 Registered at Kolad Police station |
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N.B.-tdis from should accompany witd all necessary document viz. (1)F.I.R (2)Panchanama
(3) Medical Certificate/Post-Mortem Report. |
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Inspector of police,
...........Police Station. |