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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.
:-
NAGOTHANE POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 07/2018
4.
Date,Time And Place Of Accident
:-
2018-05-09 , 11:54 , AT. VAJAROLI GAON WAKAN PALI ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) AMOL PANDURANG GAIKAR AGE 24 2) KUNAL PANDURANG GAIKAR AGE 20 BOTH AT. PATANAS
6.
Name of the Hospital to Which He/She Was Removed
:-
VAIRAGI HOSPITAL PEN TAL PEN DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 B D 6450 2) M H 05 A S 2507 , MOTOR CYCLE 2) 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
:-
1) AMOL PANDURANG GAIKAR AGE 24 AT. PATANASAI TALUKA ROHA DISTRICT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
AMOL PANDURANG GAIKAR,AT. PATANASAI TALUKA ROHA DISTRICT RAIGAD
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
:-
NAGOTHANE POLLICE STATION MOTOR ACCIDENT 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.