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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 ACCIDETN CR NO 50/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-06-13 , 20:20 , At. Borli Gaon Area Borli Mandla Road R D C Bank
5.
Name of Injured/Deceased
:-
Name Of Injured - Santosh Parshuram Jadhav At. Kakalghar Post Borli Mandala Taluka Murud Current At.
6.
Name of the Hospital to Which He/She Was Removed
:-
Anjali Hospital Alibag Taluka Alibag District Raigad
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B B 8293 2) M H 06 B U 0742 , 1) CAR 2) MOTOR CYCYEL
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 Yashawant Gharat At. Shivraj Apparment Bangale Ali Roha Taluka Roha
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
1) Nitesh Gajanan Mahalkar 2) Saurabh Sanjay Gharat ,1) At. Kolai Taluka Murud 2) Shivraj Darshan Housing Society Bagale Ali Taluka Roha
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
cholamandalam ms general insurance company , 311, Sai Leela Commercial Complex, SV Road, Borivali West, Mumbai- 400092, Maharashtra , AT. Mumbai- 400092, Maharashtra
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
3311/00/12/4974/00000,2020-05-12 , 2018-05-13
12.
Action Taken, If Any, And the Result thereof
:-
REVDANDA POLICE STATION MOTOR ACCIDENT CR NO 50/2018
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.