report - elg.satarapolice.gov.inelg.satarapolice.gov.in/files/ac/1227.pdf · form comp aa (see...

FORM COMP AA

(See Rules 253c254c(lll)2s4(80 2ss(lXlV))

REPORT ABOUTTHE MOTAR VEHICLES ACCIDENTS

L. Name of the Police station Panchsa ni oolice station

tz no'rq tpc,27g.337.338. MV Act 184, 134(AXB)2 cR.NO./TAR NO./SDE NO.

3. DATE, TIME & Place of the

accident

LOIOZI\OL\/ 08.30 A.M. Gureghar Tal mahabalesnwar

4. Name of the injured /Deceased

Sanjay vitthal mankumare, age 40, r/o Bhuteghar, tal' -Jawn'

dict qetara

5. Name of HosPitalto which

he/she was removed

Bail air hospital panchgani/ Gitanjli hospital wal

WS Rppache motar cycle no. MH 01 AQ 52596. Number of vehicles & tYPe of

vehicle

7. Name & address of the driver

of the vehicle with Perticulars

or driving license of the said

driver & the addres of the said

driving license. The number of

badge on case of Public

service Vehicle & the address

of the issuing AuthoritY of the

said badge.

Vilas sreepati gole, age 37, R/O bhouse Tal'mana

Dist. - Satara

Driving licence - MH 02 20080144101

WS Rppacne motar cycle no. MH 01AQ 5259

Owner name - Dinesh P patil R/O Darvesh bld no' 5/ 4th floar

Room no.73

8. Name & address of the Owner

of the vehicle as it stands on

the date ofthe accident.

9. Name & address of the

insurance comPanY with

whom the vehicle was insured

with the divisional office of

the assurance comPanY.

WS Rppacfre motar cycle no. MH 01AQ 5259

10. Number of insurance PolicY/

insurance certificate & the

date of validitY of the

insurance policY/ insurance

certificate.

^oeuments-Ne*avahble

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11. Action taken if anY & the

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CRIME DETAILS FORM

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report - elg.satarapolice.gov.inelg.satarapolice.gov.in/files/ac/1227.pdf · form comp aa (see...

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