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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.
:-
PALI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 01/2018
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-01-08 , 18:11 , AT. SOULVE COMPANY RAM NAGAR JOSUWADI PALI TO KHOPOLI MAIN ROAD
5.
Name of Injured/Deceased
:-
1) RAHUL RAMESH PAWAR AGE 30 AT. PALI TALUKA SUDHAGAD 2) MORESHWAR KRUSHANA WAGMARE AGE 22 AT. SINDE
6.
Name of the Hospital to Which He/She Was Removed
:-
DR. PUROHIT Plot 78, MCCH Society, Panvel, District Raigad, Navi Mumbai, Maharashtra 410206
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 12 D M 9551 2) M H 06 B H 1362 , 1) CAR 2) MOTOR CYCLE
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
:-
NARESH KRUSHANA HINDONLE AT. MOHACHI WADI TALUKA KARJAT CURRENT AT. PARLI TALUKA SUDHAGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
NARESH KRUSHANA HINDONLE ,AT. MOHACHI WADI TALUKA KARJAT CURRENT AT. PARLI TALUKA SUDHAGAD
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
:-
PALI POLICE STATION MOTOR ACCIDETN CR NO 01/2018
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.