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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.
:-
DIGHI SAGARI POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDETN NO 02/2018
4.
Date,Time And Place Of Accident
:-
2018-03-23 , 14:00 , AT. VELAS GAON BHARANA AREA
5.
Name of Injured/Deceased
:-
NAME OF INJRED - AJIT JAGANATH NAIK 2) SUJIT SITARAM NAIK AT. AGAR VELAS TALUKA SHRIWARDHAN
6.
Name of the Hospital to Which He/She Was Removed
:-
DR. BAPAT HOSPTAL AT. BORLI PANCHATAN TALUKA SHRIWARDHAN DISRTICT RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 A T 4579 2) M H 01 C K 3859 , 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
:-
SUJIT SITARAM NAIK AT. AGAR VELAS TALUKA SHRIWARDHAN
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SUJIT SITARAM NAIK,AT. AGAR VELAS TALUKA SHRIWARDHAN
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
:-
SHRIWARDHAN POLICE STATION MOTOR ACCIDETN NO 02/2018
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.