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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.
:-
RASAYANI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 71/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-08-10 , 18:49 , At. Turade Gaon Area H O C Company Get side Panvel Taluka Panvel District Raigad
5.
Name of Injured/Deceased
:-
Name Of Injured - Prashant Hanumant Hadgilkar
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC KHALAPUR TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 46 E 1910 2) M H 46 S 2716 , 1) tempo maximo 2) Motor Cycle
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
:-
Basraj Motiram Rathod At. Vaveghar Taluka Panvel
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Basraj Motiram Rathod, At. Vaveghar Taluka Panvel
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
Null , Null , Null
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
Null,0000-00-00 , 0000-00-00
12.
Action Taken, If Any, And the Result thereof
:-
RASAYANI POLICE STATION MOTOR ACCIDENT CR NO 71/2018
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.