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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 CITY POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR. NO. 71/2017
3.
Accident No.
:-
4.
Date,Time And Place Of Accident
:-
2017-10-17 , 12:30 , AT. GANDHARPALE GAON
5.
Name of Injured/Deceased
:-
1) SUCHITA SURESH INDURLKAR AGE 45 AT. SAGMESHAWAR DIST RATANAGIRI 2) PRIYANKA ANIL MOHITE AGE 45 AT
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
:-
1) M H 14 B T 0167 2) M H 20 BL 2280 , S. T BUS BOTH
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
:-
SANDEEP BHIMRAO KAMLE AT. ARNALA AGAR MUL AT. VITHAVA WARD NO 1 PUSAD TAL PUSAD DIST YAVATAMAL
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
UNKNOWN,UNKNOWN
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
:-
MAHAD CITY POLICE STATION CR. NO. 71/2017
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.