FORM 54 [See Rule 150(a) and (2)] Accident Information Report 1. Name of the police station: 2. CR No. / Traffic Accident report: 3. Date, time and place of the accident: 4. Name and full address of the injured / deceased: 5. Name of the hospital to which he / she was removed: 6. Registration Number of vehicle and the type of the vehicle: 7. Driving Licence particulars: (a) Name and address of the driver: (b) Driving licence number and date of expiry: (c) Address of the issuing authority: (d) Badge No in case of public service vehicle: 8. Name and address of the owner of the vehicle at the time of the accident: 9. Name and address of the Insurance Company with whom the vehicle was insured and the particulars of the Divisional Officer of the said insurance company: 10. Number of Insurance Policy/Insurance Certificate and the date of validity of the Insurance Policy/Insurance Certificate: 11. Registration particulars of the vehicle (class of vehicles): (a) Registration No. (b) Engine No. (c) Chassis No. 12. Route Permit Particulars: 13. Action taken, if any, and the result thereof:
