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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.
:-
POLADPUR POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 55/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-08-20 , 15:18 , At. Parlewadi Area Gaon Mumbai To Goa Road Poladpur Road Taluka Poladpur District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - Narayan Gunaji Sutar At. Kharvali Dhalkati Taluka Mahad District Raigad
6.
Name of the Hospital to Which He/She Was Removed
:-
GOVERNMENT HOSPITAL POLADPUR TAL POLADPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 46 B B 4729 2) M H 14 B T 2598 , 1) Cantrainer 2) S T Bus
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
:-
Govind Prasad Bhakat AT. Gopan Bansar District Sindhi Stat. Madhaypradesh Current At. panvel J N P T Uran District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Govind Prasad Bhakat, AT. Gopan Bansar District Sindhi Stat. Madhaypradesh Current At. panvel J N P T Uran District Raiga
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
:-
POLADPUR POLICE STATION MOTOR ACCIDENT CR NO 55/2018
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.