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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.
:-
Mandwa Sagari Police Station
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 2/2017
4.
Date,Time And Place Of Accident
:-
2017-12-10 , 21:00 , AT. NANDAI PHATA MANDAWA ALIBAG ROAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) MAHESH DATTATREY LOHAR AT. MUSHET TAL ALIBAG 2) VINIT SANDEEP PATIL AT. AAGARSU
6.
Name of the Hospital to Which He/She Was Removed
:-
CIVIL HOSPITAL ALIBAG TAL ALIBAG DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 B 2856 2) M H 06 B H 300 , 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
:-
VINIT SANDEEP PATIL AT. AAGARSURE TAL ALIBAG
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
VINIT SANDEEP PATIL,AAGARSURE TAL ALIBAG
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
:-
MANDWA SAGARI POLICE STATION MOTOR ACCIDENT NO 02/2017
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.