| 1. |
Police Station Name. |
:- |
SHRIWARDHAN POLICE STATION |
| 2. |
CR No. |
:- |
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| 3. |
Accident No. |
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MOTOR ACCIDENT NO 13/2017 |
| 4. |
Date,Time And Place Of Accident |
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2017-11-10 , 12:15 , AT. ARATHI GAON SHRIVARDHAN JASVALI ROAD |
| 5. |
Name of Injured/Deceased |
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NAME OF INJURED - SUBHAN RASHID KARDAME AGE 55 AT.BHAGMANDALA TAL SHRIVARDHAN |
| 6. |
Name of the Hospital to Which He/She Was Removed |
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SUB DIVISIONAL HOSPITAL SHRIWARDHAN TAL SHRIWARDHAN DIST RAIGAD |
| 7. |
Number Of Vehical and type Of the Vehical |
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KA 51 AA 2301 2) M H 06 BJ 3871 , CAR |
| 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 |
:- |
AKASHAY ATISH CHAVAN AT. KRUPA SADAN ENGLISH SCHOOL NATHNAGAR TAL LATUR DISRT LATUR |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
:- |
M/S ZOOM CAR INDIAN PVT.LDT,AT 7 TH FLOOR TOWER B DAIMOND HAL AIRPORT ROAD BENGALURU |
| 10. |
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company. |
:- |
THE NEW INDAIN ASSURANCE COMPNY , AT. MEKARY CIRCLE CITY BRANCH SHANKAR HOUSE NO 1 2ND FLOOR R.M.V. EXTENSION MEKHARI CIRCLE BENGALURU , BANGALURU |
| 11. |
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate. |
:- |
67160231160300011633,2018-03-15 , 2015-01-01 |
| 12. |
Action Taken, If Any, And the Result thereof |
:- |
SHRIWARDHAN POLICE STATION MOTOR ACCIDENT NO. 13/2017 |
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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. |