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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.
:-
KOLAD POLICE STATION
2.
CR No.
:-
MOTOR ACCIDENT CR NO 02/2018
3.
Accident No.
:-
NULL
4.
Date,Time And Place Of Accident
:-
2018-01-13 , 15:11 , AT. MUMBAI TO GOA HIGH WAY ROAD VARASGAON GAON RAVIZ HOTEL NEAR
5.
Name of Injured/Deceased
:-
NAME OF INJURED - VINAYAK RAJENDRA SAPALE AT. VIGHAWALI TALUKA MANGAON DISRT RAIGAD
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC AMBEWADI KOLAD TAL ROHA DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 08 A L 6554 2) M H 06 B H 6439 , CAR
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
:-
1) SANDESH PURUSHHOTTAM DHUMALE AGE 35 AT. KHAREPATAN TALUKA KANKAVALI DISRT SINDHUDURG 2) VINAYAK RAJENDRA SAPALE AT. VIGHAWALI TALUKA MANGAON DISRT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
VINAYAK RAJENDRA SAPALE,AT. VIGHAWALI TALUKA MANGAON DISRT 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
:-
KOLAD POLICE STATION MOTOR ACCIDENT CR NO 02/2018
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.