Export a Table to PDF Template | PrepBootstrap

Accidents Compension Reports

Back Photos

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.
:-
POYNAD POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 03/2018
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-01-07 , 13:30 , AT. FOZI HOTEL NERA DHARMATAR BRIDGE TALUKA PEN DISRT RAIGAD
5.
Name of Injured/Deceased
:-
NAM OF INJURED - SANJIWANI SANJAY RAUT 2) NUTAN VIJAY VARTAK 3) AHILYA VIJAY VARTAK 4) VILAS MARUTI
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
M H 46 H 1774 2) M H 20 B L 2881 , 1) TRAILER 2) BUS
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
:-
YUSUF BABU SHAIKH CURRENT AT. NARALSOPARA TALUKA VASAI DISRT PALGHAR MUL AT. ALIGAON TALUKA PATUR DISRT AKOLA
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Maharashtra State Road Transport Corporation,AT. 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
:-
POYNAD POLICE STATION MOTOR ACCIDENT CR. NO 03/2018
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.