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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.
:-
MOTOR ACCIDENT CR NO 40/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-05-17 , 09:40 , AT. MUMBAI HIGH WAY ROAD NAGOTHANE GAON KOLETI GAON NEAR
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) YASHAWANT LAXMAN PANSAKAR AT. KARANJALI PANVEL MGM HOSPITAL MAGE 2) YOGESH SAMB
6.
Name of the Hospital to Which He/She Was Removed
:-
MGM Hospital Kalmboli new panvel
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 04 GP 1079 2) M H 46 B A 0283 , 1) MINI BUS TRAVLER 2) SUZIKI BRIZA 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
:-
SAGAR BHARAT THOMBRE AGE 31 CURRENT AT. KANDIWALI THANUKARWADI TALUKA BORIEALI MUMBAI AT. MU POST WATHAR NIBALKAR TALUKA TALATAN DISTRICT RAIGAD 2) YOGESH SAMBHAJI GUNJAL AGE 27 AT. OM SAI COMPLEX ROOM NO. 41 DEVAD VICHUMBE PANVEL
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
YOGESH SAMBHAJI GUNJAL AT. OMSAI COMPLEX ROOM NO 41 DEVD VICHUMBE PANVEL ,YOGESH SAMBHAJI GUNJAL AT. OMSAI COMPLEX ROOM NO 41 DEVD VICHUMBE PANVEL
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 POLICE STATION MOTOR ACCIDENT CR NO 40/2018
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.