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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.
:-
GOREGAON POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 28/20177
4.
Date,Time And Place Of Accident
:-
2017-11-26 , 9:45 , AT. MUMBAI GOA HIGH WAY ROAD LONERE GAON NANDU GARAGE
5.
Name of Injured/Deceased
:-
NAME OF INJURED -AAYAJ HASAN CHAFEKAR AT. SAINAGAR MAHAD TAL MAHAD DIST RAIGAD
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL MANGAON TAL MANGAON DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 10 A J 4493 2) M H 06 D 5455 , 1) CAR 2) RIKSHA
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
:-
DIPAK BHARAT GHORPADE AT. DUDHONDI TAL PALUS DIST SANGALI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
DIPAK BHARAT GHORPAD,AT. DUDHONDI TAL PALUS DIST SANGALI
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
:-
GOREGAON POLICE STATION MOTOR ACCIDENT NO 28/2017
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.