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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.
:-
KHOPOLI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 180/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-10-29 , 00:53 , At. Pune To Mumbai High Way Road 38/00 Km Khalapur Taluka Khalapur District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured -- 1) Jagnanath Tukaram Hing At. Hingwathar Taluka Bhor Distrct Pune 2) Rajna Tukara
6.
Name of the Hospital to Which He/She Was Removed
:-
KHOPOLI NAGARPALIKA HOSPITAL TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 14 B 4330 2) KA 14 B 0504 , 1) S T Bus 2) Cantrainer
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
:-
Prashant Vitthal Thorat At. Girija Shankar Wadi Post Raja Kurle Khatav Satara District Satara
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Maharashtra State Road Transport Corporation Government of Maharashtra,Mumbai Central, Mumbai
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
:-
KHOPOLI POLICE STATION MOTOR ACCIDENT CR NO 180/2018
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.