| 1. |
Police Station Name. |
:- |
KHALAPUR POLICE STATION |
| 2. |
CR No. |
:- |
MOTOR ACCIDENT CR.NO 263/2017 |
| 3. |
Accident No. |
:- |
NULL |
| 4. |
Date,Time And Place Of Accident |
:- |
2017-12-18 , 18:00 , AT. HAL GAON KARJAT PHATA MUMBAI PUNE N H 04 |
| 5. |
Name of Injured/Deceased |
:- |
NAME OF INJURED - SANTOSH VISHAVNATH DESHMUKH AT. VANI POST JAMBRUG TAL KHALAPUR 2) NAVITA PRAKASH |
| 6. |
Name of the Hospital to Which He/She Was Removed |
:- |
THAKUR HOSPITAL KHOPOLI TAL KHALAPUR DIST RAIGAD |
| 7. |
Number Of Vehical and type Of the Vehical |
:- |
1) M H 46 A Q 1206 2) M H 12 P K 9388 , 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 |
:- |
SANTOSH VISHAVNATH DESHMUKH AT. VANI POST JAMBRUG TAL KHALAPUR DIST RAIGAD D L NO M H 06 20070001175 |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
:- |
SANTOSH VISHAVNATH DESHMUKH,AT. VANI POST JAMBRUG TAL KHALAPUR DIST 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 ACCIDENT CR NO 263/2017 |
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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. |