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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.
:-
ROHA POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 01/2018
4.
Date,Time And Place Of Accident
:-
2018-01-10 , 08:30 , AT. ROHA KOLAD ROAD DHATAV GAON DATHAV GRAMPANCHAYAT OFFICE ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) YOGESH SHASHIKANT RAMKAR AGE 29 AT. POST KOLAD JAYLAXMI APPARTMENT SHANIMANDIR
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL ROHA TALUKA ROHA DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 14 E R 8559 2) M H 12 A J 6693 , 1) MOTOR CYCLE 2) MINI DOOR
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
:-
YOGESH SHASHIKANT RAMKAR AGE 29 AT. POST KOLAD JAYLAXMI APPARTMENT SHANI MANDIR SHEJARI TALUKA ROHA DISRT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
YOGESH SHASHIKANT RAMKAR,AT. POST KOLAD JAYLAXMI APPARTMENT SHANI MANDIR SHEJARI TALUKA ROHA DISRT 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
:-
ROHA POLICE STATION MOTOR ACCIDENT 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.