Export a Table to PDF Template | PrepBootstrap '); popupWin.document.close(); }

Accidents Compension Reports

Back Photos

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.
:-
MHASALA POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
MOTOR ACCIDENT NO 13/2018
4.
Date,Time And Place Of Accident
:-
2018-10-24 , 15:55 , At. Mendhadi Gaon Dighi Mhasala Road
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Aalaka Krushana Khargaonkar At. Dighi Taluka Shriwardhan 2) Jagaruti Madhukar M
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC MHASALA
7.
Number Of Vehical and type Of the Vehical
:-
1) MH 14/BT--2208 2) MH 46/H-5602 , 1) S T Bus 2) Trailer
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
:-
Ishawar Laxman Bangar at. Narayan Pakhadi Shriwardhan Taluka Shriwardhan District Raigad Mul Post Karegaon Taluka Pathardi District Amhamdnaga
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Pakhadi Shriwardhan,Ishawar Laxman Bangar at. Narayan Taluka Shriwardhan District Raigad Mul Post Karegaon Taluka Patha
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
:-
MHASALA POLICE STATION MOTOR ACCEDENT NO 13 /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.