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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.
:-
GOREGAON POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR. NO 76/2017
3.
Accident No.
:-
4.
Date,Time And Place Of Accident
:-
2017-10-03 , 6:30 , AT. VADEPALE GAON GOREGAON TAL MANGAON DIST RAIGAD
5.
Name of Injured/Deceased
:-
1) DEVIDAS ARJUN KAPADE AGE 32 AT. S.T. DEPO MAHAD 2) ARUN BALIRAM MAHADIK AGE 54 AT.BHOI ALI MAHAD
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC GOREGAON TAL MANGAON DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) S T. BUS NO. M H 20 BL 3219 2) M H 46 E 2483 3) M H 43 U 2119 , TATA
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) DEVIDAS ARJUN KAPADE ST DRIVER AT. SUNDARWADI TAL MAHAD DIST RAIGAD 2) MAHAMAD NASHIM MAHAMAD LAJ
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
VITTHOBA CHANDRAKANT SALUNKHE ,AT. LADIWALI TAL MAHAD
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
:-
GOREGAON POLICE STATION MOTOR ACCIDENT CR.NO 76/2017
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.