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.
:-
MAHAD MIDC POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 23/2018
4.
Date,Time And Place Of Accident
:-
2018-05-10 , 18:32 , AT. CHANTHAVE BUDURK GAON MUMBAI TO GOA HIGH WAY ROAD TALUKA MAHAD DISTRICT RAIGAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) ABAJAL AYUB CHAIGULE AGE 30 AT. BAHIROLI TALUKA KHED DISTRICT RATANAGIRI CURREN
6.
Name of the Hospital to Which He/She Was Removed
:-
RANADE HOSPITAL MAHAD TAL MAHAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
MH04/HK0434 2) GCB ,MH06/AC5844 , MOTOR CYCLE 2) GCB
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
:-
ABAJAL AYUB CHAIGULE AGE 30 AT. BAHIROLI TALUKA KHED DISTRICT RATANAGIRI CURRENT AT. TAJAWAR NAGAR NADKAR BULDING TAL MAJALA ROOM NO MUMBRA PANVEL ROAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
ABAJAL AYUB CHAIGULE,AT. BAHIROLI TALUKA KHED DISTRICT RATANAGIRI CURRENT AT. TAJAWAR NAGAR NADKAR BULDING TAL MAJALA ROO
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
:-
MAHAD MIDC POLICE STATION MOTOR ACCIDENT NO 23/2018
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.