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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.
:-
WADKHAL POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 26/2018
4.
Date,Time And Place Of Accident
:-
2018-05-14 , 03:51 , AT. ANAND NAGAR DEVALI GAON AREA MUMABI GOA HIGH WAY ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) PRASAD ARVINDA PATIL AGE 35 2) DHANANJAY CHIMAN MAYEKAR 3) KIRAN DHANANJAY MAYE
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL TAL PEN DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) MH-08-W-3013 2) MH-48-F-2703 , 1) MH-08-W-3013 2) 2) M H-48-F-2703
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
:-
RIYAZ SAITAKAD SURKAR AT. KALANBASTE TALUKA SANGAMESHAR DISTRICT RATANAGIRI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
RIYAZ SAITAKAD SURKAR, AT. KALANBASTE TALUKA SANGAMESHAR DISTRICT RATANAGIRI
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
:-
WADAKHAL POLICE STATION MOTOR ACCIDENT NO 26/2018
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.