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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.
:-
RASAYANI POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDETN NO 09/2018
4.
Date,Time And Place Of Accident
:-
2018-03-17 , 17:22 , AT. SAVALA STOP ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJRED - 1) AJIKAY UDAY SHERAMKAR AT. ALIBAG 2) SAHIL RAJENDRA SALUNKHE AT. PANVEL
6.
Name of the Hospital to Which He/She Was Removed
:-
Niramay Hospital Plot No 148, Middle Class Society Road, Panvel, Navi Mumbai - 410206
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 A S 9703 2) M H 06 F B 8676 , 1) CAR 2) 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
:-
TRISHUL PANDURANG MALI AT. SALAV TALUAKA PANVEL
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
TRISHUL PANDURANG MALI ,AT. SALAV TALUAKA PANVEL
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
:-
RASAYANI POLICE STATION MOTOR ACCIDENT NO 09/2018
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.