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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.
:-
NAGOTHANE POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 58/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-08-10 , 07:30 , At. Vajroli Gaon Area Pali Wakan Road Roha Taluka Roha District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - Anant Namdev Ubhare At. Dharavi Shivneri Marg Kela Vakhari Side Mumbai number 17
6.
Name of the Hospital to Which He/She Was Removed
:-
P H C NAGOTHANE TAL SUDHAGAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B E 7796 2) M H 43 A N 0434 , 1) Eco Car 2) xylo ca
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
:-
Anant Namdev Ubhare At. Dharavi Shivneri Marg Kela Vakhari Side Mumbai number 17 251 M G Nagar Mul At. Ambarle Post Panelagad Taluka Mangaon District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Anant Namdev Ubhare, At. Dharavi Shivneri Marg Kela Vakhari Side Mumbai number 17 251 M G Nagar Mul At. Ambarle Post Pa
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
:-
NAGOTHANE POLICE STATION MOTOR ACCIDENT CR NO 58/2018
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.