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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.
:-
WADKHAL POLICE STATION
2.
CR No.
:-
MOTAR ACCIDENT 41/2017
3.
Accident No.
:-
4.
Date,Time And Place Of Accident
:-
2017-10-16 , 20:30 , AT.AUTO MOBAIL PETROL PUMP PANDAPUR WADKHAL TAL PEN
5.
Name of Injured/Deceased
:-
NIL
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
M H 04 EY 1957 , TRAILER
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
:-
AASIF AKHATAR HUSAIN AGE 23 R/O PIPARA AHANKAR PO; HATAWA SANT KABIR NAGAR UTTARPRADESH LICENCE NO UP 5820150002004
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
DATTATRAY B DHEMBARE,R/O KAL- 2 BLDG NO 25 PL NO 3 SECTOR NO 5E KALMBOLI TAL PANVEL DIST RIAGAD
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
UNITED INDIA INSURANCE , 914/915 SUBHASH CHANDRA BHOS MARG TAPAL NAKA PANVEL DIST RAIGAD , PANVEL
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
1210031117P106814262,2018-08-10 , 2016-01-01
12.
Action Taken, If Any, And the Result thereof
:-
WADKHAL POLICE STATION MOTOR ACCIDENT 41/2017
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.