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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.
:-
PALI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 34/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-05-25 , 22:13 , At. Nadgaon Gaon Area Bus Stop 500 M. Nandgaon to Pali Road
5.
Name of Injured/Deceased
:-
Name of Injured - Mangesh Ankush Wagmare At. Danda Aadiwashi Wadi Nandgaon Taluka Sudhagad
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 D J 6525 2) M H 46 G 4409 , 1) TEMPO 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
:-
1) Nilesh Sudhakar Patil At. Tarankhop Taluka Pen District Raigad 2) Mangesh Ankush Wagmare At. Danda Aadiwashi Wadi Nandgaon Taluka Sudhagad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Jayendra Ghanshaym Mhatre ,At. Koparoli Taluka Uran Distrtict Raigad
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
icici lombard nibhaye vaade insurance , ICICI Lombard House, 414, P.Balu Marg, Near Siddhivinayak Temple Off Swatantra, SVS Rd, Prabhadevi, , Mumbai
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
3003/14659566/00d00,2018-06-01 , 2016-01-01
12.
Action Taken, If Any, And the Result thereof
:-
PALI POLICE STATION MOTOR ACCIDENT CR NO 34/2018
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.