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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.
:-
Alibag Police Station
2.
CR No.
:-
MOTOR ACCIDENT CR NO 166/2017
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2017-12-26 , 13:15 , AT. WADGAON ALIBAG TO PEN ROAD ALIBAG TALUKA ALIBAG DIST RAIGAD
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) SANDHYA HASURAM MHATRE 2) ARCHANA DINESH PATIL BOTH AT. BALAJI GREEN CITY B WIN
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 46 W U 6954 2) M H 20 D 9721 , 1) CAR 2) S T 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
:-
KISHOR RAMCHANDRA BHOIR
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
MAHESH HASURAM MHATRE ,AT. BALAJI GREEN CITY B WING ROOM NO 304 PEN KHOPOLI ROAD UTTKASH NAGAR TAL PEN 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
:-
ALIBAG POLICE STATION MOTOR ACCIDENT CR NO 166/2017
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.