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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.
:-
PALI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 43/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-08-01 , 10:33 , At. Ambole Gaon Suprim Company near Pali Khopoli Road
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Nandu Ramesh Gavade At. Post Valaki Talukal Ahamadnagar District Ahamadnagar
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC PALI TAL SUDHAGAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 17 A G 8346 2) M H 04 G D 5998 , 1) Tempo 2) swift dzire car
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
:-
Uday Ramesh Gawade At. B 123 Ganesh Mahavir Appartment Talav Road Bhaidar East
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Uday Ramesh Gawade ,At. B 123 Ganesh Mahavir Appartment Talav Road Bhaidar East
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
:-
PALI POLICE STATION MOTOR ACCIDENT CR NO 43/2018
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.