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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.
:-
KHOPOLI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 35/2018
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-03-09 , 08:24 , AT. MUMBAI TO PUNE HIGH WAY RAOD AADOSHI GAON 36.00 KM
5.
Name of Injured/Deceased
:-
NAME OF DECEASED - BHAVIK MOHAN SHAHA AT. MUKUND NAGAR DSK BULIDNG NO 01 ROOM NO 10,11 SWARGET DISTR
6.
Name of the Hospital to Which He/She Was Removed
:-
KHOPOLI NAGARPALIKA HOSPITAL TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 12 H T 6003 2) M H 12 F C 7615 , 1) CAR 2) TRAILER
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
:-
ALTAF IRFAN SAYYAD AT. MOGALWADI KHOPOLI TALUKA KHALAPUR DISTRICT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
ALTAF IRFAN SAYYAD ,AT. MOGALWADI KHOPOLI TALUKA KHALAPUR 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
:-
KHOPOLI POLICE STATION MOTOR ACCIDTN CR NO 35/2018
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.