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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.
:-
WADKHAL POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 87/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-09-21 , 13:08 , At. Washi Gaon Area Shrm. Bhavana Ashok Thavai House Borje phat Vashi Kaleshri Road Pen Taluka Pen D
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Ajit Maruti Patil At. Vadhhav Taluka Pen District Raigad 2) Sanket Rajesh Mhat
6.
Name of the Hospital to Which He/She Was Removed
:-
MHATRE HOSPITAL PEN TAL PEN DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 B E 2264 , maxximo mini van
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
:-
Ajit Maruti Patil At. Vadhhav Taluka Pen District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Ajit Maruti Patil ,At. Vadhhav Taluka Pen 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
:-
WADAKHAL POLICE STATION MOTOR ACCIDENT CR NO 87/2018
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.