[See Rules 253 & 254 (e) (iii) 254 (80 255 (1) (iv)]
1) Name of the Police Station Neral
2) CR No./TAR No./SDE No. 009/2021
3) Date, Time and place of the accident Case Reg. Date :- 2021-01-26
Accident Date and Time:- 2021-01-26 17:05:00
Accident Place:- AT. Water Pipeline Near Neral - Matheran Ghat tal.karjat Dis. Raigad
4) Name of the injured/Deseased Rajendra Shivram Lobhi
5) Name of the hospital to which he/she was removed
6) Name of vehicle and type of the vehicle 1. Eco Taxi MH 46 BF 6686 2. Car MH 05 EN 0304
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. Rajendra Shivram Lobhi 2. Naushad Nazrul Anyari
Driver's Address:- 1. AT. Payarmal Neral Tal. Karjat Dis. Raigad 2. AT. dombivali , kalyan
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
HC/ 1245 Muneshwar Mo. No. 8087741353
Inspector of Police
Neral 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