Export a Table to PDF Template | PrepBootstrap '); popupWin.document.close(); }

Accidents Compension Reports

Back Photos

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.
:-
KHOPOLI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 102/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-07-25 , 00:46 , At. Pune To Mumbai High Way Road K M 38/471 Adoshi Goan Area Khalapur Raigad
5.
Name of Injured/Deceased
:-
Name of Injured- Pramod Raghunath Patil At. Khopoli Police Station Thane Khalapur Takula Khalapur Ra
6.
Name of the Hospital to Which He/She Was Removed
:-
KHOPOLI NAGARPALIKA HOSPITAL TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) MH 04 H S 0130 2) M H 46 B B 5500 , 1) Tempo 2) Tankar
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
:-
Mohamamd kalim Jalil Khan At. Mantram Petrol Pump Pathan Colony Pratap Nagar Road Indris Khan Chal Jalil Nagar Room No 04 Bhandup east
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Mohamamd kalim Jalil Khan, At. Mantram Petrol Pump Pathan Colony Pratap Nagar Road Indris Khan Chal Jalil Nagar Room No 04 Bh
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 STATION MOTOR ACCIDENTCR CR NO 102/2018
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.