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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.
:-
TALA POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 50/ 2017
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2017-12-26 , 16:00 , AT. KHAMVALI S T STOP TALA MANDADA ROAD TALUKA TALA DIST RAIGAD
5.
Name of Injured/Deceased
:-
NAME OF INJRED -1) ATIBA MAHAMUD KHERTAKAR AGE 25 AT. KUDA TALA TAKUKA KUDA 2) MADINA SAJJAD KHERTKA
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 06 AB 5506 2) M H 06 B B 7648 , 1) PANSO RIKSHA 2) 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
:-
JAVED IBRAHIM KARDEKAR AT. MET MOHALLA TALUKA TALA DIST RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
JAVED IBRAHIM KARDEKAR,AT. MET MOHALLA TALUKA TALA 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
:-
TALA POLICE STATION MOTOR ACCIDENT CR NO 50/2017
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.