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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.
:-
SHRIWARDHAN POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
MOTOR ACCIDENT NO 04/2018
4.
Date,Time And Place Of Accident
:-
2018-07-25 , 19:40 , Shriwardhan Harihareshwar Road At. Jaswali Gaon Dagrya
5.
Name of Injured/Deceased
:-
Name Of Injured - Taifik Rafik Khan At. Jaswali Shriwardhan Taluka Shriwardhan District Raigad
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL SHRIWARDHAN TAL SHRIWARDHAN DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 A Z 5430 , Maruti suzuki eco 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
:-
Sopan Krushan Nimare At. Kolmandala Shriwardhan Taluka Shriwardhan Current Gurav Ali At. Shriwardhan District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Sopan Krushan Nimare ,At. Kolmandala Shriwardhan Taluka Shriwardhan Current Gurav Ali At. Shriwardhan District Raigad
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
:-
SHRIWARDHAN MOTOR ACCIDENT MOTOR NO 04/2018
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.