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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.
:-
MOTOR ACCIDENT CR. NO 106/2017
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2017-11-21 , 01:45 , AT. PALI TO NANDGAON ROAD PALI CITY LAWATE CORNER
5.
Name of Injured/Deceased
:-
AT. SANGITA PRAMOD KHODAGALE AGE 49 AT. MADHALI ALI PALI TAL SUDHAGAD
6.
Name of the Hospital to Which He/She Was Removed
:-
THAKUR HOSPITAL KHOPOLI TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 A N 4595 , CAR
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
:-
MAHESH SANTOSH NAKTI AT. TULJA BHAVANI COMPLEX 2ND FLOOR ROOM NO 6 MAHAD , OLD POST OFFICE MAHAD DIST RAIGAD DL MH 062000060006886
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
MAHESH SANTOSH NAKTI, AT. TULJA BHAVANI COMPLEX 2ND FLOOR ROOM NO 6 MAHAD , OLD POST OFFICE MAHAD DIST 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
:-
PALI POLICE STATION MOTOR ACCIDENT CR. NO 106/2017
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.