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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.
:-
MAHAD MIDC POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR. NO. 59/2017
3.
Accident No.
:-
4.
Date,Time And Place Of Accident
:-
2017-10-14 , 12:00 , AT. NADGAON GAON FATAYA FRONT TURN MUMBAI GOA HIGH WAY
5.
Name of Injured/Deceased
:-
1) LAXMAN VITTHOBA AANJALERKAR AGE 70 SAVAD TAL POLADPUR DIST RAIGAD 2) SUNITA SITARAM GAIKWAD AGE 6
6.
Name of the Hospital to Which He/She Was Removed
:-
RURAL HOSPITAL MAHAD TAL MAHAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
M H 06 S 3156 , MINIDOOR RIKSHA
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
:-
LIYAKAT HASAN KARBELKAR AGE 38 AT VAVE TAL POLADPUR LIN- MH 06 20110005824 RTO PEN
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
LIYAKAT HASAN KARBELKAR AGE 38,AT VAVE TAL POLADPUR LIN- MH 06 20110005824 RTO PEN
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
THE NEW INDIA INSURANCE COMPANY BRANCH MAHAD , AT. MAHAD , MAHAD
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
17030131170200000014,2018-08-13 , 2017-01-01
12.
Action Taken, If Any, And the Result thereof
:-
MAHAD MIDC POLICE STATION MOTOR ACCIDENT CR. NO 59/2017
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.