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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 MIDC POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDETN NO 10/2018
4.
Date,Time And Place Of Accident
:-
2018-03-19 , 18:44 , eaqcbZ xksok jksMoj jktsokMh QkVk ;sFks rk- egkM AT. MUMBAI TO GOA ROAD RAJEWADI PHATA TALUKA MAHAD
5.
Name of Injured/Deceased
:-
NAME OF INJRED - MANISH RAVINDRA MORE AT. ROOM NO 01 JARI MARI SHIVAJI NAGAR GOSAVI CHAL KURLA ANDHE
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
:-
M H 03 B B 2354 2) M H 14 G H 7788 , 1) MOTOR CYCLE 2) 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
:-
MANISH RAVINDRA MORE AT. ROOM NO 01 JARI MARI SHIVAJI NAGAR GOSAVI CHAL KURLA ANDHERI ROAD MUMBAI 72 MUL AT. PANGARI MOREWADI TALUKA MAHAD DISTRICT RAIGAD
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
MANISH RAVINDRA MORE,AT. ROOM NO 01 JARI MARI SHIVAJI NAGAR GOSAVI CHAL KURLA ANDHERI ROAD MUMBAI 72 MUL AT. PANGARI MORE
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 MIDC POLICE STATION MOTOR ACCIDETN NO 10/2018
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.