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 Mangaon
2) CR No./TAR No./SDE No. 022/2022
3) Date, Time and place of the accident Case Reg. Date :- 2022-02-05
Accident Date and Time:- 2022-02-05 10:15:00
Accident Place:- MUMBAI GOA HIGHWAY, MANGAON BAJARPETH, NEAR HDFC BANK, TAL-MANGAON
4) Name of the injured/Deseased ENJURED-1) VIVEK RAGHUNATH SHIGVAN, AT- TALEGAON WADI, TAL- MANGAON, 2) NAUSHAD SHOUKAT GAIBI, LONSHI MOHALLA, TAL-MANGAON.
5) Name of the hospital to which he/she was removed
6) Name of vehicle and type of the vehicle BIKE MH06BY2737, BIKE MH04FB4803
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:- NAUSHAD SHOUKAT GAIBI,
Driver's Address:- LONSHI MOHALLA, TAL-MANGAON.
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 279.337,338, MVA 184
HC/ KHIRIT MANGAON PS
Inspector of Police
Mangaon 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