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Accidents Compension Reports

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FORM COMPP AA
[see Rules 253,254 (c) (iii),254(80 255(1)(iv)]
REPOR ABOUT THE MOTOR VEHICLES ACCIDENTS

No
Contents
:-
Data
1.
Police Station Name.
:-
RASAYANI POLICE STATION
2.
CR No.
:-
cr no 54/2018 IPC 304 A, 279,337,338, mv act 184,134
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-06-28 , 18:00 , at chambharli village dand fata aapta road
5.
Name of Injured/Deceased
:-
Deceased Person 1) Pratik Waman Mali
6.
Name of the Hospital to Which He/She Was Removed
:-
CHAIK RURAL HOSPITAL KHALAPUR TALUKA KHALAPUR DISTRICT RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
2 , Activa Scooter and unknown vehical
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
:-
unknown
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
:-
cr no 54/2018 IPC 304 A, 279,337,338, mv act 184,134 register at rasayani police station
N.B.-tdis from should accompany witd all necessary document viz. (1)F.I.R (2)Panchanama (3) Medical Certificate/Post-Mortem Report.
Inspector of police, ...........Police Station.