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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.
:-
MANGAON POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 02/2018
4.
Date,Time And Place Of Accident
:-
2018-01-12 , 07:00 , AT. UMAROLI GAON
5.
Name of Injured/Deceased
:-
NAME OF INJURED - ) SAHADEV APPAJI DALVI AGE 75 2) SANDEEP BABAN DALVI AGE 50 BOTH AT. UMROLI TALUKA
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B B 9372 2) M H 06 B Q 5318 , 1) MOTOR CYCLE 2) SCOOTY
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
:-
VAIBAHV PRAKASH JADHAV AT. BORGHAR ADHIWASHI WADI TALA TALUKA TALA DISRT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
PRAKASH JADHAV ,AT. BORGHAR ADHIWASHI WADI TALA TALUKA TALA 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
:-
MANGAON 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.