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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 200/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-10-26 , 10:39 , At. Mumbai To Goa High Way Road Area Hotel Pushpak Near Pen Taluka Pen District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - Pankaj Bhalchandara Patil At. Umbarde Taluka Pen
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL TAL PEN DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 46 A R 2433 , 1) M H 46 A R 2433 2) M H 06 B B0919
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
:-
Satendra Ramsing Hasan Chaudhari At. L Logistic Jasadu Taluka Uaran Mul Khandarai Post Gokulpura Taluka Band District Mainathbajar Stat. Uttarpradesh
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Satendra Ramsing Hasan Chaudhari ,At. L Logistic Jasadu Taluka Uaran Mul Khandarai Post Gokulpura Taluka Band District Mainathbajar S
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 200/2018
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.