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. 192/2021
3) Date, Time and place of the accident Case Reg. Date :- 2021-07-31
Accident Date and Time:- 2021-07-30 01:00:00
Accident Place:- AT. Mumbai-Pune Expressway K. M. 29 Tel. Khalapur Dist. Raigad Maharashtra
4) Name of the injured/Deseased 1. Akash Ganesh Chougule 2. Vijay Sukhdev Pawar 3. Pthukumar Shaminath Sahani 4. Rajendra Ramtilak Yadav 5. Shifa Bilal Shaikh 6. Alfaaz Najim Makamdar 7. Shushant Shashikant Gaikwad 8. Bhagyashree Gaikwad 9. Shivsena Datta Gaikwad 10. Rupali U
5) Name of the hospital to which he/she was removed None
6) Name of vehicle and type of the vehicle Bus MH 01 DR 0272
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:- Ramesh Sambhaji Thorat
Driver's Address:- AT. Karve Tel. Karad Dist. Satara
Licence No:- None
8) Name and address of the owner of the vehicle as it stands on the date of accident Owner Name:- None
9) Name and address of the insurance company with whom the vehicle was insured and the divisional office of the said insurance company
10) Number of Insurance policy/Insurance certificate and the Date of validity of the insurance Policy/Insurance certificate
11) Action taken, if any and the result thereof FIR Report
HC 834 Mhatre Mo. No. 7307332553
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