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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.
:-
MOTOR ACCIDENT CR. NO.74/2017
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2017-11-27 , 12:30 , AT. KENBURLI GAON MUMBAI GOA HIGH WAY TAL MAHAD DIST RAIGAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - KRUSHANA DAGADU UTTEKAR AGE 20 AT. DATTAKRUPA CHAL NAV YUG TARUN MANDAL RAM NAGAR
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
:-
M H 02 E N 9642 , 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
:-
PRASHANT NAMDEV SANAS AGE 22 AT. MUKADAM CHAL KASAR VASAVLI GHODBANDAR ROAD DIST THANE MUL AT. WADGHAR TAL POLADPUR DIST RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
PRASHANT NAMDEV SANAS , AT. MUKADAM CHAL KASAR VASAVLI GHODBANDAR ROAD DIST THANE MUL AT. WADGHAR TAL POLADPUR DIST RAIGAD
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 POLICE STATION MOTOR ACCIDENT CR. NO 74/2017
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.