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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.
:-
ROHA POLICE STATION
2.
CR No.
:-
40/2018 IPC 279,337,338, MV Act 184
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-04-19 , 18:00 , At Pingalsai Village Alibag Roha Village
5.
Name of Injured/Deceased
:-
Injured Person 1) Kisan Dhondu Thakur 2) Revati Kisan Thakur
6.
Name of the Hospital to Which He/She Was Removed
:-
Dr Sanjay Mali Clinik Mangaon
7.
Number Of Vehical and type Of the Vehical
:-
2 , Motor Cycle & Scorpio Car
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
:-
Bandu Kadu Full Name Not Known
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 40/2018 IPC 279,337,338, MV Act 184 at Roha 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.