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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.
:-
POLADPUR POLICE STATION
2.
CR No.
:-
POLADPUR POLICE STATION MOTOR ACCIDENT CR NO 49/2017
3.
Accident No.
:-
4.
Date,Time And Place Of Accident
:-
2017-10-13 , 10:30 , AT. PARLE GAON SMASHANBHUMI MUMBAI GOA HIGH WAY NO 66 ROAD
5.
Name of Injured/Deceased
:-
NAME OF DECEASED - NILAM AMBAJI KAMBLE AGE 38 AT. CHANTHAVE 2) ABHIBAI URF RANIBAI BABURAO JADHAW AG
6.
Name of the Hospital to Which He/She Was Removed
:-
GOVERNMENT HOSPITAL POLADPUR TAL POLADPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) MH 04 J F 1015 2) M H 06 S 3459 , 1) ACCER TEMPO 2) MINIDOOR 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
:-
VIKAS GULAB YADAV AGE 32 AT. GULAB YADAV EKOINI PESARA JAINPUR STAT UTTARPRADESH
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
UNKNOWN,UNKNOWN
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
:-
POLADPUR POLICE STATION MOTOR ACCIDENT CR NO 49/2017
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.