| 1. |
Police Station Name. |
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DADAR SAGARI POLICE STATION |
| 2. |
CR No. |
:- |
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| 3. |
Accident No. |
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MOTOR ACCIDENT NO 02/2018 |
| 4. |
Date,Time And Place Of Accident |
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2018-01-10 , 14;23 , AT. HAMARAPUR PHATA MUMBAI TO GOA HIGH WAY ROAD |
| 5. |
Name of Injured/Deceased |
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NAME OF INJURED - NIL |
| 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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MH 06/k/6046 , CANTRAINER |
| 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 |
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RAVI SHANKAR BADALURAM SING MUL AT. MAIYAMA TALUKA SWARAO DISRT ALAHABAD STAT. UTTARPRADESH CURRENT AT. JASAI NAVHASHEWA TALUKA URAN DISRT RIAGAD |
| 9. |
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident |
:- |
UNKNOWN,UNKNOWN |
| 10. |
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company. |
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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 |
:- |
DADAR SAGARI POLICE STATION MOTOR ACCDIEDNT NO 02/2018 |
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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. |