| 1. |
Police Station Name. |
:- |
KHALAPUR POLICE STATION |
| 2. |
CR No. |
:- |
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| 3. |
Accident No. |
:- |
MOTOR ACCIDENT NO 39/2018 |
| 4. |
Date,Time And Place Of Accident |
:- |
2018-06-14 , 15:00 , At. Pune To Mumbai High Way Road High k m 29Taluka Khalapur |
| 5. |
Name of Injured/Deceased |
:- |
Name Of Injured - Sarik Kadar Basar At. Kulam Kasar Basar Gani GandhiNagar Taluka tripura District S |
| 6. |
Name of the Hospital to Which He/She Was Removed |
:- |
NIL |
| 7. |
Number Of Vehical and type Of the Vehical |
:- |
TN 52 J 7911 , Truck |
| 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 |
:- |
Sarik Kadar Basar At. Kulam Kasar Basar Gani GandhiNagar Taluka tripura District Samdhipura Stat. tamilnadu |
| 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 STATIO MOTOR ACCIDENT NO 39/2018 |
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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. |