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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.
:-
RASAYANI POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
MOTOR ACCIDENT NO 24/2018
4.
Date,Time And Place Of Accident
:-
2018-10-01 , 12:07 , At. Patalganga Gaon Area Indian Oli Pump Side Relince Parking Road
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Dilip Pandurang Dhumal 2) Paras Dilip Dhumal
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC Rasayani Taluka Khalapur District Raigad
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B N 1607 2) M H 13 R 2592 , 1) TATA Truck 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
:-
Rajesh Kumarlal Bachan Sahni At. Ward no 09 Navin Vasati Dak Bangal Mukatipath Chillapur Barhalgang Gorakhapur Stat. Uttarpradesh
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Rajesh Kumarlal Bachan Sahni, At. Ward no 09 Navin Vasati Dak Bangal Mukatipath Chillapur Barhalgang Gorakhapur Stat. Uttarprades
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
:-
Rasayani Police Station Motor Accident No 24/2018
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.