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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.
:-
POLADPUR POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 55/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-08-24 , 20:24 , At. Parlewadi Gaon Area Smashan Bhumi Mumbai To Goa High Way Road
5.
Name of Injured/Deceased
:-
Name Of Injured- 1) Nitin Raghunath Korade At. Thakkar Park B wing 304 Kalyan West District Thane 2
6.
Name of the Hospital to Which He/She Was Removed
:-
GOVERNMENT HOSPITAL POLADPUR TAL POLADPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 14 GH 9839 , innova xylo
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
:-
Nitin Raghunath Korade At. Thakkar Park B wing 304 Kalyan West District Thane
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Nitin Raghunath Korade, At. Thakkar Park B wing 304 Kalyan West District Thane
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
:-
POLADPUR POLICE STATION MOTOR ACCIDENT NO 55/2018
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.