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Accidents Compension Reports

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FORM COMPP AA
[see Rules 253,254 (c) (iii),254(80 255(1)(iv)]
REPOR ABOUT THE MOTOR VEHICLES ACCIDENTS

No
Contents
:-
Data
1.
Police Station Name.
:-
MAHAD CITY POLICE STATION
2.
CR No.
:-
--
3.
Accident No.
:-
MOTOR ACCIDENT NO 13/2018
4.
Date,Time And Place Of Accident
:-
2018-07-16 , 15:32 , At. Keburli Gaon Area Mumbai To Goa High Way Road
5.
Name of Injured/Deceased
:-
Name Of Injured - Nil
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
M H 08 H 2491 , Cantainer
8
Name and Address Of the Driver Of the Vehical With Particulars Or Driving License Of the Said Driver And the Address Of Issuing Autdority Of the Said Driving License.the Number Of Badge in Case Of Public Service Vehical and Address of Issuing Autdority Of the Said Badge
:-
Ramchandra Jejeram Hajare At. Gonewadi Taluka Mangalveda District Solapur Current Hatkhamba Titha Taluka Ratangiri District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Dipak Pandurang Gajare ,At. Hat Khamba Tithe Ratangiri District Ratanagiri
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
New India Assurance Company , 31, Javar Peth, Ratnagiri , At. Ratanagiri
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
17060331170100002702,2018-08-09 , 2017-08-10
12.
Action Taken, If Any, And the Result thereof
:-
MAHAD CITY POLICE STATIION MOTOR ACCIDENT NO 13/2018
N.B.-tdis from should accompany witd all necessary document viz. (1)F.I.R (2)Panchanama (3) Medical Certificate/Post-Mortem Report.
Inspector of police, ...........Police Station.