Export a Table to PDF Template | PrepBootstrap '); popupWin.document.close(); }

Accidents Compension Reports

Back Photos

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.
:-
MURUD POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 2/2018
4.
Date,Time And Place Of Accident
:-
2018-03-05 , 19:34 , AT. VIHUR PETROL PUMP
5.
Name of Injured/Deceased
:-
NAME OF INJURED - NIL
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 B P 0403 , CAR
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
:-
MITESH RAMESH JAGATAP AT. GAON DEVI PAKHADI TALUKA MURUD MUL AT. MADHURLILA BULDING PLAT NO 111 SECTOR NO 02
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
MITESH RAMESH JAGATAP,AT. GAON DEVI PAKHADI TALUKA MURUD MUL AT. MADHURLILA BULDING PLAT NO 111 SECTOR NO 02
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
:-
MURUD 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.