| 1. |
Police Station Name. |
:- |
KHOPOLI POLICE STATION |
| 2. |
CR No. |
:- |
--- |
| 3. |
Accident No. |
:- |
MOTOR ACCIDENT NO 79/2018 |
| 4. |
Date,Time And Place Of Accident |
:- |
2018-07-13 , 18:38 , At. Pune To Mumbai High Way Road Khopoli exit Adoshi Gaon Taluka Khalapur |
| 5. |
Name of Injured/Deceased |
:- |
Name Of Injured - Nil |
| 6. |
Name of the Hospital to Which He/She Was Removed |
:- |
NIL |
| 7. |
Number Of Vehical and type Of the Vehical |
:- |
J H 05 AT 6565 , Tata Tipper |
| 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 |
:- |
Shubham Kumar Prasad At. Bagun Nagar Adarsha Nagar Taluka Bardih Post Jamshedpur Zharkhand Driver lince no. J h 0520130000040 |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
:- |
Shubham Kumar Prasad, At. Bagun Nagar Adarsha Nagar Taluka Bardih Post Jamshedpur Zharkhand Driver lince no. J h 0520130 |
| 10. |
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company. |
:- |
Null , Null , Null |
| 11. |
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate. |
:- |
Null,0000-00-00 , 0000-00-00 |
| 12. |
Action Taken, If Any, And the Result thereof |
:- |
KHOPOLI POLICE STATION MOTOR ACCIDENT NO 79/2018 |
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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. |