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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.
:-
REVDANDA POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT NO 117/2017
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2017-10-27 , 19:45 , AT. ALIBAG TO REVDANDA ROAD CHAIL GAON TULADDEVI
5.
Name of Injured/Deceased
:-
NAME OF INJURED - SHESHANTH NARAYAN NAIK AGE 65 AT. POST CHAIL DEVI TAL ALIBAG
6.
Name of the Hospital to Which He/She Was Removed
:-
KEM Hospital Acharya Donde Marg Parel, Mumbai 400012
7.
Number Of Vehical and type Of the Vehical
:-
MH 06AY 6270 , 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
:-
SANDIP VIJAY POTDAR AT. VITTHAL NAGAR SONAR ALI MURUD TAL MURUD DIST RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SANDIP VIJAY POTDAR,AT. VITTHAL NAGAR SONAR ALI MURUD TAL MURUD DIST RAIGAD
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
:-
REVDANDA POLICE STATION MOTOR ACCIDENT CR.NO 117/2017
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.