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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.
:-
KHALAPUR POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
Motor Accident Cr no 53/2018
4.
Date,Time And Place Of Accident
:-
2018-10-08 , 22:51 , At. Ghodiwali Fatha Mumbai To Pune N H 04 High Way Road Taluka Khalapur
5.
Name of Injured/Deceased
:-
Name Of Injured - ) Ganesh Anil More At. Malad Purv Mumbai 2) Ishwar Prakash Jadhav At. Mahad Purv M
6.
Name of the Hospital to Which He/She Was Removed
:-
Pratvati Hospital Khalapur Taluka Khalapur District Raigad
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 47 Z 0850 2) M H 46 B J 3621 , 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
:-
Ganesh Anil more At. janseva Chal kameti Ambedkar Nagar Wagheshwari Mandir Malad Purv Mumbai
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Ganesh Anil more, At. janseva Chal kameti Ambedkar Nagar Wagheshwari Mandir Malad Purv Mumbai
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
:-
khalapur police Station Motor Accident No 53/2018
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.