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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.
:-
NAGOTHANE POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
05/2018
4.
Date,Time And Place Of Accident
:-
2018-04-20 , 19:30 , At Nagothane Village Mumbai Goa Highway
5.
Name of Injured/Deceased
:-
Injured Person 1) Dipak Shankar Rajivale
6.
Name of the Hospital to Which He/She Was Removed
:-
PRACHIN HEALTH CARE MULCIPARTI HOSPITAL PANVEL TAL PANVEL
7.
Number Of Vehical and type Of the Vehical
:-
2 , 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
:-
Dipak Shankar Rajivale At Marath Ali Nagothane Tal Roha
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 05/2018 resisted at nagothane polie 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.