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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.
:-
MURUD 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 , 12:10 , AT. NAVIN MAJGAON KASA GAON STOP TALUKA MURUD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - HANNAN NISAR PANGARKAR AGE 27AT. VIHUR BAG MOHALA TALUKA MURUD DISRT RAIGAD
6.
Name of the Hospital to Which He/She Was Removed
:-
CIVIL HOSPITAL ALIBAG TAL ALIBAG DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B L 9179 2) M H 14 C W 2356 , 1) M H 06 B L 9179 2) M H 12 C W 2356
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
:-
1) HANNANA NISAR PANGARKAR AGE 27 AT. VIHUR BHAG MOHALLA TAKUKA MURUD DISRT RIAGAD 2) DYANANAD GOVINDA CHAVHAN AGE 53 CCM COLONY BUILDING NIGADI JAGAT NAKA DISRT PUNE
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
HANNANA NISAR PANGARKAR , AT. VIHUR BHAG MOHALLA TAKUKA MURUD DISRT RIAGAD
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
:-
MURUD 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.