| 1. |
Police Station Name. |
:- |
KHALAPUR POLICE STATION |
| 2. |
CR No. |
:- |
MOTOR ACCIDENT CR.NO. 234/2017 |
| 3. |
Accident No. |
:- |
NULL |
| 4. |
Date,Time And Place Of Accident |
:- |
2017-11-01 , 11:00 , AT. MUMBAI PUNE HIGH WAY ROAD KHALAPUR TAL KHALAPUR DIST RAIGAD |
| 5. |
Name of Injured/Deceased |
:- |
NAME OF DECEASED - DATTATREY SAKHARAM TAVARE AT PLAT 41 BULIDING NO H 1 A WING SHRIRANG C H S DUKO |
| 6. |
Name of the Hospital to Which He/She Was Removed |
:- |
PHC KHALAPUR TAL KHALAPUR DIST RAIGAD |
| 7. |
Number Of Vehical and type Of the Vehical |
:- |
M H 04 DY 7649 , CAR |
| 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 |
:- |
DATTATREY SAKHARAM TAVARE AT PLAT 41 BULIDING NO H 1 A WING SHRIRANG C H S DUKO BANK THANE WEST |
| 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 |
:- |
KHALAPUR POLICE STATION MOTOR ACCIDENT CR. NO 234/2017 |
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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. |