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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.
:-
GOREGAON POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 56/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-10-11 , 17:53 , At. Lonere Phata Santosh Pan Stol Lonere Road Mangaon Taluka Mangaon
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Suman Kashinath navale At. Lonere Taluka Mangoan 2) Ramchandra Mahipat Gavaskar
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC GOREGAON TAL MANGAON DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 A G 9943 2) M H 06 B M 3687 , 1) Pik up 2) wagenr 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
:-
Khubaib Amir Ahamad Khan At. Lonere Taluka Mangaon
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Khubaib Amir Ahamad Khan, At. Lonere Taluka Mangaon
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
:-
Goregaon Police Station Motor Accident CR no 56/2018
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.