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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.
:-
MOTOR ACCIDETN CR NO 22/2018
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-02-19 , 22:37 , AT. MAHALUGE GAON ADHIWASHI WADI ROAD ROHA
5.
Name of Injured/Deceased
:-
NAME OF INJURED - JITENDRA CHNDRAKANT MHATRE AT. MAHALUNGE POST SHEDSAI TALUKA ROHA DISTRICT RAIGAD
6.
Name of the Hospital to Which He/She Was Removed
:-
CIVIL HOSPITAL ALIBAG TAL ALIBAG DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B H 6467 2) M H 06 B L 0386 3) M H 06 B L 0386 , 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
:-
1) JITENDRA CHNDRAKANT MHATRE AT. MAHALUNGE POST SHEDSAI TALUKA ROHA DISTRICT RAIGAD 2) NANDU LAXMAN SUTAR AT. MITHEKHAR TALUKA MURUD DISTRICT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
JITENDRA CHNDRAKANT MHATRE, AT. MAHALUNGE POST SHEDSAI TALUKA ROHA DISTRICT 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 CR NO 22/2018
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.