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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 ACCIDENT NO 24/2018
4.
Date,Time And Place Of Accident
:-
2018-05-14 , 23:25 , AT. ISANE KAMBALE GAON SATAYA MAHASEL NEAR TALUKA MAHAD DISTIRCT RAIGAD
5.
Name of Injured/Deceased
:-
NAME 0F DECEASED - AMIR AHAMAD KONDVILKAR NAME OF DECEASED - 1) NAJIB NASIR FALNAYAK AGE 18 AT. T
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 08 U 4504 , 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
:-
NAJIB NASIR FALNAYAK AGE 18 AT. TEMGHAR TALUKA MAHAD DISTRICT RAIGAD MUL. MHAPRAL TALUKA MANDANGAD DISTIRCT RATNAGIRI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
NAJIB NASIR FALNAYAK NAJIB NASIR FALNAYAK , AT. TEMGHAR TALUKA MAHAD DISTRICT RAIGAD MUL. MHAPRAL TALUKA MANDANGAD DISTIRCT RATNAGIRI
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 ACCIDENTCR NO 24/2018
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.