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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.
:-
WADKHAL POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 37/2018
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-03-22 , 20:05 , AT. KARAVI GAON MUMBAI GOA HIGH WAY ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - RUPESH PANDURANG KAMBALE AT. B-11 SAI SADAN CO OPP. HOUSING SOCITY NAVGHAR ROAD J
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL TAL PEN DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 46 A F 7286 2) M H 05 B T 2192 , 1) TRAILER 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
:-
1)RAVIDNRA PANDURANG KAMBALE AT. B - 11 SAI SADAN CO OPP.HOSING SOCETY NAVGHAR ROAD JAIN NAGAR BADALI DISTRICT THANE 2) PREMCHAND GULABCHAND AT. RAJPUR GIJIPUR CONTOMENT ROAD VARANASHI STAT. UTTARPRADESH CURRENT PADAMAVATI PETROLIAM VINEGAON TALUKA KHALAPUR DISTRICT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
RAVIDNRA PANDURANG KAMBALE ,AT. B - 11 SAI SADAN CO OPP.HOSING SOCETY NAVGHAR ROAD JAIN NAGAR BADALI DISTRICT THANE
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
:-
WADKHAL POLICE STATION MOTOR ACCIDENT CR NO 37/2018
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.