| 1. |
Police Station Name. |
:- |
KHOPOLI POLICE STATION |
| 2. |
CR No. |
:- |
MOTOR ACCIDETN CR NO 109/2018 |
| 3. |
Accident No. |
:- |
--- |
| 4. |
Date,Time And Place Of Accident |
:- |
2018-08-05 , 14:05 , At. Khopoli Shahu Sabhagruha Mumbai To Pune Old High Way Road Khalpur District Raigad |
| 5. |
Name of Injured/Deceased |
:- |
Name Of Deceased - Narendra Dattatrey Sakhare At. ShilFata Khopoli Taluka Khalapur |
| 6. |
Name of the Hospital to Which He/She Was Removed |
:- |
KHOPOLI NAGARPALIKA HOSPITAL TAL KHALAPUR DIST RAIGAD |
| 7. |
Number Of Vehical and type Of the Vehical |
:- |
M H 46 A C 3513 , Riksha |
| 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 |
:- |
Vilas Yashwant Bandal At. Savaroli Taluka Khalapur |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
:- |
Vilas Yashwant Bandal ,At. Savaroli Taluka Khalapur Taluka Khalapur District Raigad |
| 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 |
:- |
KHALAPUR POLICE STATION MOTOR ACCIDENTCR CR NO 109/2018 |
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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. |