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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 ACCIDETN CR NO 177/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-10-28 , 16:41 , At. Pune To Mumbai HighWay Road Adoshi Gaon Area 38/500 Khopoli Taluka Khalapur Ditrict Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Asha shivakumar Garodiaya At. E -12 NavPrabhat society Sant Janabhai Road Vile
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
:-
M H 14 G Y 2831 , Maruti Suzuki Ertiga
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
:-
Vinod Mahadev Pasare At. Durgamata Colony shivshankar Galli No 01 Near Chakrapani Vasahat Bhosari Pune Vinod Mahadev Pasare At. Durgamata colony Shivshankar Galli No 01 Side chakrapali Vasawhat Bhosari Pune
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Vinod Mahadev Pasare ,At. Durgamata Colony shivshankar Galli No 01 Near Chakrapani Vasahat Bhosari Pune Vinod Mahadev Pasa
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 177/2018
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.