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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.
:-
GOREGAON POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 53/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-09-15 , 16:28 , At. Goregaon Aayodhya Nagar Goregaon Lonere Road Mangaon Taluka Mangoan District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Manish Tukaram Dhasade At. Devali Taluka Mangaon District Raigad 2) Saurbh Kon
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL MANGAON TAL MANGAON DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B Z 4398 2) M H 04 B Y 8847 , 1) Hyundai Santro 2) Motor Cycle
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
:-
Krunal Balu Dhepe At. Repoli Taluka Mangaon District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Krunal Balu Dhepe, At. Repoli Taluka Mangaon 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
:-
GOREGAON POLICE STATION MOTOR ACCIDENT CR NO 53/2018
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.