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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.
:-
KHALAPUR POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 02/2018
4.
Date,Time And Place Of Accident
:-
2018-01-04 , 06:30 , AT. MUMBAI PUNE HIGH WAY N H 04 ROAD KALOTE GAON RISHBHA HOTEL NEAR 500 MITER TALUKA KHALAPUR
5.
Name of Injured/Deceased
:-
1) GULAB GOVINDA GAIKWAD AGE 53 2) GANESH BHIMRAO LOKHANDE AGE 33 3) GANESH SAHEBRAO RASHHE AGE 18 A
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC KHALAPUR TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 14 D M 3286 , PIC UP
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
:-
AVINASH NANDARAM VARPE AT. KALMB VARPE MALA AMBEGAON DISRT PUNE
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
AVINASH NANDARAM VARPE ,AT. KALMB VARPE MALA AMBEGAON DISRT PUNE
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
:-
KHALAPUR POLICE STATION MOTOR ACCIDENT NO 02/2018
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.