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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.
:-
MHASALA POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 07/2018
4.
Date,Time And Place Of Accident
:-
2018-05-06 , 03:45 , AT. MHASALA SHRIWARDHAN ROAD NEW ENGLISH SCHOOL
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) SANTOSH CHANDRAKANT VANKAR AGE 45 AT. KAJINPE POST SAIGAON TALUKA SHRIWAARDHAN
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC MHASALA
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 J 1136 2) M H 02 B U 3804 , RISKA 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
:-
AKASHA BALU RAJPUT AGE 18 AT/ MHASALA NAVANAGAR TALUKA MHASALA 2) SANTOSH CHANDRAKANT VANKAR AGE 45 AT. MUL KALINJE POST SAIGAON TALUKA SAIGAON TALUKA SHRIWARDHAN
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SANTOSH CHANDRAKANT VANKAR AGE 45, AT. MUL KALINJE POST SAIGAON TALUKA SAIGAON 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
:-
MHASALA POLICE STATION MOTOR ACCEDENT NO 07 /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.