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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.
:-
MAHAD CITY POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
MOTOR ACCIDENT NO 25/2018
4.
Date,Time And Place Of Accident
:-
2018-09-25 , 19:51 , At. Butala Petrol Pump Near Mumbai To Goa Road Mahad Taluka Mahad District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - Subhagi Shivaji Jadhav At. Kharvali Taluka Mahad District Raigad
6.
Name of the Hospital to Which He/She Was Removed
:-
RURAL HOSPITAL MAHAD TAL MAHAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) 1) M H 06 G 8554 2) M H 02 D G 3760 , 1) Tempo 2) Maruti Suzuki Ertiga 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
:-
Rajendra Dattaram Chavhan At. Krushana Classic A wing Ram Mandir Road Babai Naka Borawali west Thane
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Rajendra Dattaram Chavhan, At. Krushana Classic A wing Ram Mandir Road Babai Naka Borawali west Thane
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
:-
MAHAD CITY POLICE STATIION MOTOR ACCIDENT NO 25/2018
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.