FORM COMP AA

[See Rules 253 & 254 (e) (iii) 254 (80 255 (1) (iv)]
REPORT ABOUT THE MOTOR VEHICLE ACCIDENT
1) Name of the Police Station Khalapur
2) CR No./TAR No./SDE No. 009/2021
3) Date, Time and place of the accident Case Reg. Date :- 2021-01-07
Accident Date and Time:- 2021-01-07 16:00:00
Accident Place:- AT. Lodhivali Village Place Pune-Mumbai NH 04 highway Road Abhi Beer Shop Samor Tal.Khalapur Dis. Raigad
4) Name of the injured/Deseased Anil Mothichand Choudhril
5) Name of the hospital to which he/she was removed Notfind
6) Name of vehicle and type of the vehicle 1. Truck MH 18 AA 8960 2. Bick MH 06 AD 1397
7) Name and address of the driver of the vehicle with particular or driving licence of the said driver and the address of the issuing authority of the said driving licence. The number of badge in case of public service vehicle and the address of the issuing authority of the said badge Driver Name:- 1. Unknown Vehicle Drive 2. Anil Mothichand Choudhril
Driver's Address:- 1. Unknown Vehicle Drive 2. Vinayak Kadam Chhaawl Poyanje Ta. Panvel Dis. Raigad Mo.No. 7330875400
Licence No:- Notfind
Licence's Issuing Authority:- Notfind
Badge No:- Notfind
Badge's Issuing Authority:- Notfind
8) Name and address of the owner of the vehicle as it stands on the date of accident Owner Name:- Notfind
Owner's Address:- Notfind
9) Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance company Insurance Company:- Notfind
Insurance's Company Address:- Notfind
Insurance Company Divisonal Office:- Notfind
10) Number of Insurance policy/Insurance certificate and the Date of validity of the insurance Policy/Insurance certificate Insurance Policy No:- Notfind
11) Action taken, if any and the result thereof FIR Report
HC/ 1907 Patil
Inspector of Police
Khalapur Police Station
N. B. - This form should accompany with all the necessary document viz. (1) I.R. (2) Panchanama (3) Medical certificate /Post Motern Report