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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 43/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-06-01 , 13:48 , At. Mumbai To Goa High Way Road Sukeli Khindi Nagothane Side
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) Raghunath Dattaram Marane 2) Rakesh Balu Raut Age 27 Both At. Vave Taluka Manga
6.
Name of the Hospital to Which He/She Was Removed
:-
sukeli jidala hospita Nagothane Taluka Roha District Raigad
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B M 1751 2) M H 08 G 9912 3) M H 04 G M 7067 4) M H 06 B K 2455 , 1) CAR 2) TRUCK 3) 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
:-
Gajanan Gotiram Pethavi At. Dolvi Taluka Pen District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Gajanan Gotiram Pethavi, At. Dolvi Taluka Pen District Raigad
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 43/2018
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.