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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.
:-
NAGOTHANE POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 66/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-09-23 , 15:15 , At. Nagothane Gaon Area Mumbai To Goa High Way Road Shambu Petrol-Pump Roha Taluka Roha
5.
Name of Injured/Deceased
:-
Name Of Injured - Sudhir Mahadev Mendhadkar At. Turmbardi Post Mendali Mhasala Taluka Mhasala Distri
6.
Name of the Hospital to Which He/She Was Removed
:-
P H C NAGOTHANE TAL SUDHAGAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 46 E 7004 2) M H 46 A V 2614 , 1) Pik Up Jeep 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
:-
Gangaram Ramchandra Hirave At. Valan Brudruk Teradewadi Taluka Mahad District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Gangaram Ramchandra Hirave ,At. Valan Brudruk Teradewadi Taluka Mahad 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
:-
NAGOTHANE POLICE STATION MOTOR ACCIDENT CR NO 66/2018
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.