Export a Table to PDF Template | PrepBootstrap '); popupWin.document.close(); }

Accidents Compension Reports

Back Photos

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.
:-
KHOPOLI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 73/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-06-01 , 00:19 , At. Gandi Hospital Panvel Navi Mumabai
5.
Name of Injured/Deceased
:-
NAME OF DECEASED - Arvind Lalbihiri Sing At. Tembhewadi Suresh Deshamukh Chal Khopoli Mul At. Orgai
6.
Name of the Hospital to Which He/She Was Removed
:-
GANDHI HOSPITAL 142, MCCH Society, Near Kohinoor Technical Institute, Old Panvel, Mumbai, Maharasht
7.
Number Of Vehical and type Of the Vehical
:-
M H 46 B A 3161 , 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
:-
Sevalal Harilal Rajbhar At. Krushana Nagar Khopoli Mul At. Dhorara Taluka Ambedkarnagar District Ambedkar Nagar Stat. Uttapradesh
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Sevalal Harilal Rajbhar ,At. Krushana Nagar Khopoli Mul At. Dhorara Taluka Ambedkarnagar District Ambedkar Nagar Stat. Uttapr
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 STAITON MOTOR ACCIDENT CR NO 73/2018
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.