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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 CITY POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 72/2017
4.
Date,Time And Place Of Accident
:-
2017-11-24 , 10:40 , AT. MUMBAI GOA HIGH WAY ROAD KENDRULI TAL MAHAD DIST RAIGAD
5.
Name of Injured/Deceased
:-
NAME OF DECEASED - VISHAL VASANT SHINDE AGE 27 AT. VAVE TAL POLADPUR DIST RAIGAD 2) MANGESH SENAPAT
6.
Name of the Hospital to Which He/She Was Removed
:-
RURAL HOSPITAL MAHAD TAL MAHAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 S 9334 2) RC 200 , 1) VAN 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
:-
INDRAJIT MACHINDRA THOBARE AGE 28 AT. KOTESHWAR TALE MAHAD TAL MAHAD DIST RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
UNKNOWN ,UNKNOWN
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 CITY MOTOR ACCIDENT NO 72/2017
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.