1) | Name of the Police Station | Poyanad |
2) | CR No./TAR No./SDE No. | 098/2021 |
3) | Date, Time and place of the accident |
Case Reg. Date :- 2021-11-29 Accident Date and Time:- 2021-11-29 12:22:00 Accident Place:- kurdus nagadew nagar kopari velege taluaka alibag district raigad |
4) | Name of the injured/Deseased | 1)vikas naturam nisal 2) atisha lakashman mhatre |
5) | Name of the hospital to which he/she was removed | none |
6) | Name of vehicle and type of the vehicle | 1) dampar mh05 am1990 2) baik mh 43 w5221 3) bus mh04 jp0956 |
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) vivek dipak mhatre 2) dhramandr kumar kisunatha pal 3)vikas naturam nisal Driver's Address:- 1)रा.शहाबाजपो.पोयनाडता.अलिबागजि.रायगड 2), रा. सध्यारा.रूमनं 5अगोरखनाथचाळनित्यानंदनगरघाटकोपरइस्टमुबंईकायमचापत्तारा.दर्यापुरता.रानीगंजजि.प्रतापगडराज्यउत्तरप्रदेश , मुबंई, मुंबई , महाराष्ट्र, फोननंबर 8454869683 3)रा.बिडवागळेपो.कुर्डुसता.अलिबागजि.रायगड Licence No:- NIL Licence's Issuing Authority:- NIL Badge No:- NIL Badge's Issuing Authority:- NIL |
8) | Name and address of the owner of the vehicle as it stands on the date of accident |
Owner Name:- NIL Owner's Address:- NIL |
9) | Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance company |
Insurance Company:- NIL Insurance's Company Address:- NIL Insurance Company Divisonal Office:- NIL |
10) | Number of Insurance policy/Insurance certificate and the Date of validity of the insurance Policy/Insurance certificate | Insurance Policy No:- NIL |
11) | Action taken, if any and the result thereof | पोयनाडपोस्टेगुरनं 0098/2021 भा.दं.वि.क. 304 A, 279,337,338 , मोटारवाहनअधिनियम, 1988 184 प्रमाणे |
सपोनिश्रीअतिग्रेमोनं 9146478561 | ||
Inspector of Police | ||
Poyanad 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 |