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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.
:-
POLADPUR POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 33/2018
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-05-15 , 23:44 , AT. LOHARMAL GAON HOTEL BALAJI NEAR MUMBAI GOA HIGH WAY ROAD TALUKA POLADPUR DISTRICT RAIGAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) SAJID ISSAC MULLA 2) NISSARUDDIN ILILYAGUZ AGE 40 BOTH AT. MIRAKARWADA TALUKA R
6.
Name of the Hospital to Which He/She Was Removed
:-
GOVERNMENT HOSPITAL POLADPUR TAL POLADPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 08 A P 0129 , PIK UP JEEP
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
:-
SAJID ISSAC MULLA AT. MIRAKARWAD TALUKA RATNAGIRI DISTRICT RATNAGIRI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SAJID ISSAC MULLA,AT. MIRAKARWAD TALUKA RATNAGIRI DISTRICT RATNAGIRI
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
:-
POLADPUR POLICE STATION MOTOR ACCIDENT CR NO 33/2018
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.