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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.
:-
KHOPOLI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 273/2017
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2017-12-29 , 12:37 , AT. MUMBAI – PUNE N H 04 OLD HIGH WAY KHOPOLI SAYMAL GAON OLD HIGH WAY CHOUKI NAG MODI ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJURD - AKSHAY SHANTARAM GHOLAP 2) RAHUL ANNASAHEB BORUDE AT. DONGARGAON POST LONAWALA TAL
6.
Name of the Hospital to Which He/She Was Removed
:-
Jakhotia Hospital Shastrinagar, Sri Swami Samarth Nagar, Khopoli, Maharashtra 410203
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 14 A S 3727 2) M H 05 C M 4138 , 1) MOTOR CYCLE 2) CAR
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
:-
SUNIL SUBHASH GAIKWAD AGE 27 PLAT NO 178 SHIVPRASAD CO OPTECTIVE HOUSING SOCIETY SANSAI SECTION AMBARNATH EAST DISRT THANE
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
:-
KHOPOLI POLICE STATION MOTOR ACCIDENT CR NO 273/2017
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.