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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.
:-
PALI POLICE STATION
2.
CR No.
:-
----
3.
Accident No.
:-
Motor Accident no 10/2018
4.
Date,Time And Place Of Accident
:-
2018-09-13 , 17:44 , At. Pedali Gaon Area Shivraj Hotel Near Pali Khopoli Road
5.
Name of Injured/Deceased
:-
Name Of Injured - Two Unknown Preson Motor cycle Driver
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 14 D N 5181 2) M H 12 F N 3902 , 1) Mahindra Bolero Jeep 2) Motor Cycel
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
:-
Ganesh Shantaram Shevakari At. Plat No 63 Parijat Society Talegaon Station Taluka Maval District Pune
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Ganesh Shantaram Shevakari, At. Plat No 63 Parijat Society Talegaon Station Taluka Maval District Pune
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
:-
Pali Police Station Motor Accident no 10/2018
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.