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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.
:-
KOLAD POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDETN NO 05/2018
4.
Date,Time And Place Of Accident
:-
2018-03-12 , 00:49 , AT. PUI GAON STOP MUMBAI GOA HIGH WAY ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED --1) NAVNATH RAMJI BARJE AGE AT. HEDAVALI POST ENGHAR TALUKA ROHA 2) MAGESH DEVRAM L
6.
Name of the Hospital to Which He/She Was Removed
:-
KOKANE HOSPITAL. NAGOTHANE TALUKA SUDHAGAD DISTRICT RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 B S 4869 2) M H 43 X 8825 , 1) MOTOR CYCLE 2) 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
:-
NAVNATH RAJMI BARJE AT. HEDAVLI POST ENGHAR TALUKA ROHA
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
NAVNATH RAJMI BARJE ,AT. HEDAVLI POST ENGHAR TALUKA ROHA
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
:-
KOLAD POLICE STAITON MOTOR ACCIDENT NO 05/2018
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.