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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 06/2018
4.
Date,Time And Place Of Accident
:-
2018-01-15 , 14:24 , AT. PUNE TO MUMBAI HIGH WAY ROAD KM 36/450 SAJGAON GAON NEAR
5.
Name of Injured/Deceased
:-
NAME OF INJURED - NIL
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
M H 46 A F 0039 , CANTRAINER
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
:-
SADDAM MOHAMAD KALLAN AT. MALIKPUR POST NONARA TALUKA KADIPUR DISRT SULTANABAD STAT. UTTARPRADESH CURRENT AT. BHATIYA SHIPING LINE URAN LINE NO. 4420160003211
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
M S BHATIYA ,AT. URAN PANVEL DISRT NAVI MUMBAI
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
general bajaj allianz insurance , GE PlazaAirport Road, Blue Hill SocietyYerwada, Pune - 411006 Landmark: OPPOSITE Gunjan Cinema , PUNE
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
Null,2017-06-13 , 2016-01-01
12.
Action Taken, If Any, And the Result thereof
:-
KHOPOLI POLICE STATION MOTOR ACCIDENT NO 06/2018
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.