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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 MIDC POLICE STATION
2.
CR No.
:-
----
3.
Accident No.
:-
MOTOR ACCIDENT NO 7/2018
4.
Date,Time And Place Of Accident
:-
2018-10-10 , 21:03 , At. Vaikhol Gaon Area Ganesh Nagar Ram Temple Taluka Mahad District Raigad
5.
Name of Injured/Deceased
:-
Name Of Deceased - 1)Ashok Virppa Sindgi at. Shetgiri Taluka Sahapur District Yadgir Stat.Karnatak 2
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC Pachad Mahad Taluka Mahad District Raigad
7.
Number Of Vehical and type Of the Vehical
:-
M H 04 C P 2369 , Truck
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
:-
Jaysing Somnath Yadav at. SamataNagar Society no 3 Distict Thane
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Jaysing Somnath Yadav, at. SamataNagar Society no 3 Distict 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 MIDC POLICE STATION MOTOR ACCIDENT NO 37/2018
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.