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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 19/2018
4.
Date,Time And Place Of Accident
:-
2018-09-12 , 13:15 , At. Vahur Area Mumbai To Goa High Way Road Taluka Mahad District Raigad
5.
Name of Injured/Deceased
:-
Name oF Injured-- Ankit Ashok Shitawadikar At. Vadat Taluka Guhagar District Ratanagiri Current Room
6.
Name of the Hospital to Which He/She Was Removed
:-
RURAL HOSPITAL MAHAD TAL MAHAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 47 AC 6827 , Motor Cycle shine
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
:-
Ankit Ashok Shitawadikar At. Vadat Taluka Guhagar District Ratanagiri Current Room no 2 Gunduchi Chal Shanakar Mandir Ketkipada Dahisar East Mumbai
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Ankit Ashok Shitawadikar, At. Vadat Taluka Guhagar District Ratanagiri Current Room no 2 Gunduchi Chal Shanakar Mandir Ketkip
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
:-
MAHAD CITY POLICE STATIION MOTOR ACCIDENT NO 19/2018
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.