Export a Table to PDF Template | PrepBootstrap '); popupWin.document.close(); }

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.
:-
MANGAON POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 165/2018
3.
Accident No.
:-
-----
4.
Date,Time And Place Of Accident
:-
2018-09-19 , 23:59 , At. Goa To Mumbai Road Mnagon balaram hotel Mangaon Taluka Mangaon District Raigad
5.
Name of Injured/Deceased
:-
Name Of Deceased - Prakash Hiru Surve At.Nalore Mangaon Taluka Mangaon District Raigad
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 H 0218 2) M H 46 B B 4813 , 1) Motor Cycel 2) Cantrianer
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
:-
Guddu Radhekant Gujar At. Kushiyera Post matwar Taluka Lalganj District Mirajpur Stat. Uttarpradesh
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Unknown,Unknown
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
:-
MANGAON POLICE STATION MOTOR ACCIDET CR NO 165/2018
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.