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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.
:-
KHOPOLI POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 157/2018
3.
Accident No.
:-
---
4.
Date,Time And Place Of Accident
:-
2018-10-05 , 02:19 , At. Borghat Pune To Mumbai Old High Way Shingareba Mandir Khopoli Gaon Area Takula Khalapur Distric
5.
Name of Injured/Deceased
:-
Name Of Injured - 1) Aasha Nandakishor Osaval At. khopoli 2)Manju Ashok Jain At. Khopoli 3) Sundar B
6.
Name of the Hospital to Which He/She Was Removed
:-
KHOPOLI NAGARPALIKA HOSPITAL TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
MH 04 FK 1257 , Travlers Bus
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
:-
Sanjay Ram Koshte At. Hanuman Koliwada Uran Taluka Uran District Navi MumbaiSanjay Ram Koshte At. Hanuman Koliwada Uran Taluka Uran District Navi Mumbai
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Sanjay Ram Koshte, At. Hanuman Koliwada Uran Taluka Uran District Navi Mumbai
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
:-
KHOPOLI POLICE STATION MOTOR ACCIDENT CR NO 157/2018
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.