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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.
:-
RASAYANI POLICE STATION
2.
CR No.
:-
RASAYANI POLICE STATIO MOTOR ACCIDENT NO 35/2017
3.
Accident No.
:-
4.
Date,Time And Place Of Accident
:-
2017-10-13 , 7:15 , AT. JATADE GAON RASAYANI CORNER TO CON ROAD
5.
Name of Injured/Deceased
:-
NAME TO INJURED - ABHIJIT ANANT PATIL AT NAVIN POSARI TAL KHALAPUR DIST RAIGAD
6.
Name of the Hospital to Which He/She Was Removed
:-
MGM Hospital Kalmboli new panvel
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 06 H C 7950 2) M H 46 AY 8745 , 1) CONTRENER 2) 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
:-
RAM ARAJ VARMA AGE 43 AT KARIMPUR LIN-VP62- 201550007243
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
KOMARA ARUN BORAD,UNKNOWN
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
reliance journal insurance , AT. MUMBAI , MUMBAI
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
११०५२७२३३४००५०९४,2017-03-18 , 2017-03-17
12.
Action Taken, If Any, And the Result thereof
:-
RASAYANI POLICE STATION MOTOR ACCIDENT NO 35/2017
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.