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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.
:-
DADAR SAGARI POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 10/2018
4.
Date,Time And Place Of Accident
:-
2018-05-14 , 20:20 , At.Hotel Park In Sahara Gaon Mumbai to Goa High Way Road
5.
Name of Injured/Deceased
:-
NAME OF INJURED - Vilas Sitaram Mokal At. C.P.W.D OFFICE NEAR MALL VELE PARLE PURV MUMBAI AT. VONI T
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL TAL PEN DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
MH/02/DE-8691 2) MH.46/AR0257 , 1) MOTOR CYCLE 2) DUMMER
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
:-
Vilas Sitaram Mokal At. C.P.W.D OFFICE NEAR MALL VELE PARLE PURV MUMBAI AT. VONI TALUKA RAJEPUR DISTRICT RATANAGIRI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Vilas Sitaram Mokal,At. C.P.W.D OFFICE NEAR MALL VELE PARLE PURV MUMBAI AT. VONI TALUKA RAJEPUR DISTRICT RATANAGIRI
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
:-
DADAR SAGARI POLICE STATION MOTOR ACCIDENT 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.