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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.
:-
MOTAR ACCIDENT 136/2017
3.
Accident No.
:-
MOTOR ACCIDENT NO. 136/2017
4.
Date,Time And Place Of Accident
:-
2017-10-06 , 3:30 AM , AT. MUMBAI PUNE HIGH WAY ROAD N H 4 KHOPOLI TAL KHALAPUR DIST RAIGAD
5.
Name of Injured/Deceased
:-
NAME OF DECEASED - ROHIDAS RAMCHANDRA ROHIWAL AGE 45 AT. HAIR OM COMPLEX ROOM NO.701 SECTOR 18 KAMKO
6.
Name of the Hospital to Which He/She Was Removed
:-
MGM Hospital Kalmboli new panvel
7.
Number Of Vehical and type Of the Vehical
:-
M H 45 F 8054 , TEMPO
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
:-
ROHIDAS RAMCHANDRA ROHIWAL AGE 45 AT. HAIR OM COMPLEX ROOM NO.701 SECTOR 18 KAMKOTE DIST NAVI MUMBAI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
UNKNOWN,UNKNOWN
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 ACCIDENT NO 136/2017
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.