| 1. |
Police Station Name. |
:- |
POLADPUR POLICE STATION |
| 2. |
CR No. |
:- |
MOTOR ACCIDENT CR NO 77/2017 |
| 3. |
Accident No. |
:- |
NULL |
| 4. |
Date,Time And Place Of Accident |
:- |
2017-12-29 , 13:15 , AT. KASARAWADI TO RANVADI GAON PULAJAVAL TALUKA POLADPUR DISRT RAIGAD |
| 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 |
:- |
1) M H 06 B W 0070 2) M H 07 C 7202 , 1) PIC UP 2) 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 |
:- |
KAILAS SHAMRAO SALONKHE AT. GONDALE LADVALI PULAJAWAL TALUKA MAHAD DISRT RAIGAD |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
:- |
KAILAS SHAMRAO SALONKHE,AT. GONDALE LADVALI PULAJAWAL TALUKA MAHAD DISRT 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 |
:- |
POLADPUR POLICE STATION MOTOR ACCIDENT CR NO 77/2017 |
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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. |