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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.
:-
KHALAPUR POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 91/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-05-21 , 11:07 , AT. BAGESHRI HOTEL MUMBAI PUNE N H 04 ROAD HAL GAON ARAE DARUGA KHALAPUR
5.
Name of Injured/Deceased
:-
NAME OF INJURED - SURESH JAGANANTH SALAVI AT. VARDHAMAN NAGAR KHOPOLI TALUKA KHALAPUR
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC KHALAPUR TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 11 B L 3089 2) M H 06 A R 3647 , 1) PICUP 2) MOTOR CYCLE
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
:-
SADIK ALI RAFIKCHAND SHAIKH AT. POST MALGAON TALUKA SATAR DISTRICT SATARA 2) SURESH JAGANATH SALVI AT. VARMAN NAGAR KHOPOLI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SURESH JAGANATH SALVI, AT. VARMAN NAGAR KHOPOLI
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
:-
KHALAPUR POLICE STATION MOTOR ACCIDEND CR NO 91/2018
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.