Export a Table to PDF Template | PrepBootstrap '); popupWin.document.close(); }

Accidents Compension Reports

Back Photos

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.
:-
KHALAPUR POLICE STATION
2.
CR No.
:-
Cr No 65/2018 IPC 279,337 MV Act 184
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-04-12 , 11:15 , At AApati Village front of petrol pump
5.
Name of Injured/Deceased
:-
Injure Person 1) Bhimrao More 2) Keshav Govind 3) Santosh Tukaram Malkar
6.
Name of the Hospital to Which He/She Was Removed
:-
Rural Hospial Vavoshi Khalapur
7.
Number Of Vehical and type Of the Vehical
:-
2 , ST Bus & 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
:-
Ravindra Damodar Nitanvare At Sanjay Nagar Galli no 16 Mukund wadi Aurangabad (ST Driver)
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
:-
Cr No 65/2018 IPC 279,337 MV Act 184 Register At Khalapur police station
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.