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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.
:-
13/2018
4.
Date,Time And Place Of Accident
:-
2018-04-20 , 17:30 , Front of Vinanti Company Gate Mahad MIDC Road
5.
Name of Injured/Deceased
:-
Injured Person 1) Kunal Vijay Mohite 2) Narayan Tatyaba Garud
6.
Name of the Hospital to Which He/She Was Removed
:-
M . M. A HOSPITAL MAHAD MIDC TAL MAHAD DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1 , Motor Cycle
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
:-
Kunal Vijay Mohite At Kalij Bauddha wadi Birwadi Tal Mahad
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Unknown,Unknown
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
:-
motor accident 13/2018 registered at Mahad MIDC Police station
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.