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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.
:-
NERAL POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT NO. 21/2017
3.
Accident No.
:-
4.
Date,Time And Place Of Accident
:-
2017-10-03 , 6:00 , KARJAT MURBAD ROAD KALAMB GHAT
5.
Name of Injured/Deceased
:-
1) RITESH TUKARAM SHINDE 2) TUSHAR VASANT MORE BOTH AT. OTUR TAL JUNNAR DIST PUNE
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC KALAMB NERAL TAL KARAJT
7.
Number Of Vehical and type Of the Vehical
:-
MH 43 U 386 , TRUCK
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
:-
TUSHAR VASANT MORE AT. OTUR TAL JUNNAR DIST PUNE
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
RANDHIR JAYRAM KADAM ,AT. ALEPHATA DIST PUNE
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
:-
NERAL POLICE STATION MOTOR ACCIDENT NO 21/2017
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.