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 74/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-06-01 , 19:06 , At. Mumbai To Pune High way Road 35/00 SajGaon Gaon Area Indian Petrol Pump Taluka Khalapur Distric
5.
Name of Injured/Deceased
:-
1) Sushil Shrikrushan Bhandare At. Room no 502 Resodemny Plat no 161 Sector 10, KharGhar Navi Mumbai
6.
Name of the Hospital to Which He/She Was Removed
:-
MEDI CITY HOSPITAL KHARGHAR NAVI MUMBAI
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 01 B Y 6067 2) M H 46 X 9645 , 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
:-
Sushil Shrikrushan Bhandare At. Room no 502 Resodemny Plat no 161 Sector 10, KharGhar Navi Mumbai
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Sushil Shrikrushan Bhandare, At. Room no 502 Resodemny Plat no 161 Sector 10, KharGhar Navi Mumbai
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 74/2018
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.