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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.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 160/2017
4.
Date,Time And Place Of Accident
:-
2017-12-14 , 23:00 , AT. PUNE MUMBAI HIGH WAY KHOPOLI EXIT KM 40/500 TAL KHALAPUR
5.
Name of Injured/Deceased
:-
NAME OF INJURED - VISHANU VITTHOBA GAIKWAD
6.
Name of the Hospital to Which He/She Was Removed
:-
D Y PATIL HOSPITAL NAVI MUMBAI
7.
Number Of Vehical and type Of the Vehical
:-
M H 46 H 9020 , TRELAR
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
:-
VISHANU VITTHOBA GAIKWAD AT. PO/PAWARWADI KADLAS TAL SANGOLA DIST SOLAPUR DL NO MH 45 20090002844
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
ASHOK VISHANU DHANSE ,AT., A 103 VASTU SHANTI PLOT NO 13 SEC 11 KALAMBOLI NODE
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
reAPPLE PLAZA UNIT , NO. 301 302 AND 303 SENPATILBAPAT MARGE DADAR WEST MUMBAI , MUMBAI
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
110827772334002188,0000-00-00 , 0000-00-00
12.
Action Taken, If Any, And the Result thereof
:-
KHOPOLI POLICE STATION MOTOR ACCIDENT NO 160/2017
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.