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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 07/2018
4.
Date,Time And Place Of Accident
:-
2018-01-13 , 2:00 , AT. PUNE TO MUMBAI HIGH WAY ROAD AADOSHI GOAN KHOPOLI EXIT 60 MITER
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 06 A G 6084 , TEMPO
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
:-
ISARAR AHAMAD KHAN AT. SHOP NO 2 SIDDHIKI BULDING DADA SAHEB PHALAKE ROAD DADAR PURV MUMBAI 14 MUL AT. SATALAPURAVA POST SEMARI CHAKPIHANI POST THANE BHINAGA STAT. UTTARPRADESH
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
ISARAR AHAMAD KHAN ,AT. SHOP NO 2 SIDDHIKI BULDING DADA SAHEB PHALAKE ROAD DADAR PURV MUMBAI 14
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
:-
KHOPOLI POLICE STATION MOTOR ACCIDENT NO 07/2018
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.