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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.
:-
REVDANDA POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 47/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-06-04 , 00:38 , At. Cheher Harsh chinese centrel Salav To Roha Dambari Road
5.
Name of Injured/Deceased
:-
Anil Balaram Chavarkar Age 45 At. Navin Cheher Taluka murud District Raigad
6.
Name of the Hospital to Which He/She Was Removed
:-
CIVIL HOSPITAL ALIBAG TAL ALIBAG DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) MH06BL8710 2) MH06BC3730 , MOTOR CYCEL
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
:-
Sanjay Mahadev Wagmare Age 22 At. bobadghar Post Chanera Taluka Roha District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Vivek Vasant Chavarkar Age. 31, At. Navin Cheher Post Walke Taluka Murud
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
:-
REVDANDA POLICE STATION MOTOR ACCIDENT CR NO 47/2018
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.