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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.
:-
PEN POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 201/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-10-26 , 23:46 , At. Khopoli To Pen Road Ambeghar Gaon Area Ganesh Chainij Hotel Near Pen Taluka Pen District Raigad
5.
Name of Injured/Deceased
:-
Name Of Deceased - Vishal vilas Mule At. Pune Name Of Deceased - 1) Anil Vinod Prajapatil At. Hetav
6.
Name of the Hospital to Which He/She Was Removed
:-
MGM Hospital Kalmboli new panvel
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 14 D X 3180 2) M H 06 B R 8625 , 1) Eco Car 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
:-
Nitin Kashinath Vetal At. Hetavane Taluka Pen
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Nitin Kashinath Vetal, At. Hetavane Taluka Pen District Raigad
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
:-
PEN POLICE STATION MOTOR ACCIDENT CR NO 201/2018
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.