[See Rules 253 & 254 (e) (iii) 254 (80 255 (1) (iv)]
1) Name of the Police Station Pali
2) CR No./TAR No./SDE No. 0007/201
3) Date, Time and place of the accident Case Reg. Date :- 2021-01-23
Accident Date and Time:- 2021-01-18 20:00:00
Accident Place:- AT. Pali-Vakan Road Valap Village Nursery Near Tal. Sudhagad
4) Name of the injured/Deseased Pravin Prakash Bhoir
5) Name of the hospital to which he/she was removed Not find
6) Name of vehicle and type of the vehicle 1. Car MH 14 HD 4923 2. Bike MH 06 CB 2294
7) Name and address of the driver of the vehicle with particular or driving licence of the said driver and the address of the issuing authority of the said driving licence. The number of badge in case of public service vehicle and the address of the issuing authority of the said badge Driver Name:- 1. Prakash Govind Shinde 2. Pravin Prakash Bhoir
Driver's Address:- 1. AT. Vishal Residency b wing 3rd floor flat 11 A kasarwadi tal. Haveli Dis. Pune 2.
Licence No:- Not find
8) Name and address of the owner of the vehicle as it stands on the date of accident Owner Name:- Not find
9) Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance company
10) Number of Insurance policy/Insurance certificate and the Date of validity of the insurance Policy/Insurance certificate
11) Action taken, if any and the result thereof FIR Report
PN/1263 Ghase
Inspector of Police
Pali Police Station
N. B. - This form should accompany with all the necessary document viz. (1) I.R. (2) Panchanama (3) Medical certificate /Post Motern Report