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 Rasayani
2) CR No./TAR No./SDE No. 011/2022
3) Date, Time and place of the accident Case Reg. Date :- 2022-02-05
Accident Date and Time:- 2022-01-28 10:30:00
Accident Place:- RASAYANI SAVLA MARGE PANVEL ROAD, AT RASAYANI, TAL- KHALAPUR
4) Name of the injured/Deseased DEATH-1) ANIKET ANIL TANDEL, AT- GAJANAN, ROOM NO 417, GULSUNDE, TAL-PANVEL
5) Name of the hospital to which he/she was removed MGM HOSPITAL KAMOTHE
6) Name of vehicle and type of the vehicle BIKE NUMBER NOT KNOWN, UNKNOWN VEHICAL
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:- UNKHOWN
Licence No:- NIL
8) Name and address of the owner of the vehicle as it stands on the date of accident Owner Name:- NIL
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 CRIME REGISTER IPC 304(A),279.337,338, MVA 184,134
API GUND RASAYANI PS
Inspector of Police
Rasayani 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