| 1. |
Police Station Name. |
:- |
NAGOTHANE POLICE STATION |
| 2. |
CR No. |
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08/2018 |
| 3. |
Accident No. |
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NULL |
| 4. |
Date,Time And Place Of Accident |
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2018-02-02 , 13:30 , At Nidi front of Aishwarya Hotel mumbai goa highway road |
| 5. |
Name of Injured/Deceased |
:- |
Deceased - Ghanshyam Dinesh Sapre |
| 6. |
Name of the Hospital to Which He/She Was Removed |
:- |
J. J. HOSPITAL MUMBAI DIST MUMBAI |
| 7. |
Number Of Vehical and type Of the Vehical |
:- |
2 , Trailer & 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 |
:- |
Unknown |
| 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. |
:- |
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 |
:- |
Registred C R No at Nagothane Police Station C R No 08/2018 IPC 304 A 279,337,338 m v act 184,134 |
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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. |