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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 274/2017
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2017-12-29 , 17:47 , AT. ANDOSHI GAON 37:200 KM
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) SARVESTIN SAVER NAIRAN AGE 38 2) JEISU SARVSTIN NAIRAN AGE 8 3) SANTOSH SAVERA
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
M H 02 B J 6778 , 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
:-
SANTOSH SARVERA NAIRAN AT. MILAN CHAL ROOM NO 06 AMBOLI CHURCH KAL NIKETAN BULDING SAMOR ANDHERI WEST MUMBAI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SANTOSH SARVERA NAIRAN,AT. MILAN CHAL ROOM NO 06 AMBOLI CHURCH KAL NIKETAN BULDING SAMOR ANDHERI WEST MUMBAI
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 274/2017
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.