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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.
:-
Mangaon Cr No 25/2018 IPC 304A,279,337,338 mv act 184
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-02-08 , 04:00 , Front of dipak hotel indapur Mumbai goa highway road
5.
Name of Injured/Deceased
:-
Deceased Person Sumit Shridhar Patil Injured Abhijit Prakash Ramgadkar
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL MANGOAN
7.
Number Of Vehical and type Of the Vehical
:-
1 , Hundai I20
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
:-
Sumit Shridhar Patil At diveaagar Shrivardhan
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Unknown,Unknown
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 Cr No 25/2018 IPC 304A,279,337,338 mv act 184 Registered at Mangaon Police station
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.