Export a Table to PDF Template | PrepBootstrap

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.
:-
KHALAPUR POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 160/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-08-13 , 20:33 , At. Madap Khalapur Taluka Khalapur District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Sanjal Sandip Onti At. Room no 201 A wing Aman Co- operating Society Plat No 26
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC KHALAPUR TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1)M H 11 B H 7008 2) M H 43 N E 6412 3) M H 43 B G 7443 , 1) Scorpio Car 2) irtika 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
:-
Kisan Ramchandra Hegadkar At. Malewadi Sagavi Taluka Faltan District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Kisan Ramchandra Hegadka,r At. Malewadi Sagavi Taluka Faltan 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
:-
KHALAPUR POLICE STAITON MOTOR ACCIDENT CR NO 160/2018
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.