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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.
:-
MHASALA POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 31/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-09-12 , 16:30 , At. Kadalwada Gaon Area Mhasala Majgaon Road Mhasala Taluka Shriwardhan District Raigad
5.
Name of Injured/Deceased
:-
Name Of Deceased -Ravindra Mahadev Shedage At. Varal Post Majgaon Taluka Tala District Raigad Name
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC MHASALA
7.
Number Of Vehical and type Of the Vehical
:-
M H 43 B H 5176 , 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
:-
Paresh Devji Varand At. Varal Post Majgaon Taluka Tala District Raigad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Paresh Devji Varand, At. Varal Post Majgaon Taluka Tala District 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
:-
MHASALA POLICE STATION MOTOR ACCEDENT CR NO 51 /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.