| 1. |
Police Station Name. |
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PEN POLICE STATION |
| 2. |
CR No. |
:- |
---- |
| 3. |
Accident No. |
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MOTOR ACCIDENT NO 27/2018 |
| 4. |
Date,Time And Place Of Accident |
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2018-08-05 , 12:40 , At. Pen S T Depo Area Pen |
| 5. |
Name of Injured/Deceased |
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Name Of Deceased - Suresh Gangaram Sirbud age 75 Lokmanya Hoousing Society Pen Taluka Pen District R |
| 6. |
Name of the Hospital to Which He/She Was Removed |
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NIL |
| 7. |
Number Of Vehical and type Of the Vehical |
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M H 20 B L 2432 , S T BUS |
| 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 |
:- |
Shatrughan Dyanoba Kendra At. S.T Depo District Raigad |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
:- |
Government of Maharashtra,Mumbai Central, Mumbai |
| 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 |
:- |
PEN POLICE STATION MOTOR ACCIDENT NO 27/2018 |
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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. |