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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.
:-
RASAYANI POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
MOTOR ACCIDENT NO 28/2018
4.
Date,Time And Place Of Accident
:-
2018-11-02 , 06:40 , At. Ris Gaon Area 18/678 Km Pune to Mumbai High Way Road Taluka Khalapur District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Sandip Jaychandra Sing At. Lidapur Jalain Dist. Lidaipur St. Uttarpradesh 2)Far
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 12 M V 3191 2) K A 01 A H 8294 , tempo eicher
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
:-
Hasib Ali Hakim Ali At. Gadwar Aamamamu District Pratapgad Stat. Uttrapradesh
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Hasib Ali Hakim Ali ,At. Gadwar Aamamamu District Pratapgad Stat. Uttrapradesh
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
:-
RASAYANI POLICE STATION MOTOR ACCIDENT NO 28/2018
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.