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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.
:-
KHALAPUR POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDETN NO 17/2018
4.
Date,Time And Place Of Accident
:-
2018-03-09 , 19:12 , AT. KUBHIWALI GAON MUMBAI TO PUNE HIGH WAY RAOD 30.00 KM
5.
Name of Injured/Deceased
:-
NAME OF INJURED - AMOL SHASHIKANT YADAV AT. KALYAN CITY SHEJARI GADHIGALJA DISTRICT KOLHAPUR
6.
Name of the Hospital to Which He/She Was Removed
:-
Ashtvinayak Hospital Ploat No.10, Sector-6, Khanda Colony, Near Khandeshwar Lake,New Panvel(W), Navi
7.
Number Of Vehical and type Of the Vehical
:-
MH 09 EM 2855 , TRUCK
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
:-
AMOL SHASHIKANT YADAV AT. KALYAN CITY SHEJARI GADHIGALJA DISTRICT KOLHAPUR
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
AMOL SHASHIKANT YADAV,AT. KALYAN CITY SHEJARI GADHIGALJA DISTRICT KOLHAPUR
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
:-
KHALAPUR POLICE STAITON MOTOR ACCIDENT NO 17/2018
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.