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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.
:-
RASAYANI POLICE STATION
2.
CR No.
:-
3.
Accident No.
:-
MOTOR ACCIDENT NO 39 /2017
4.
Date,Time And Place Of Accident
:-
2017-10-30 , 1:00 , AT. PUNE MUMBAI HIGH WAY ROAD KM 18 RIS GAON
5.
Name of Injured/Deceased
:-
NAME OF INJURED - SATYANARAYAN RAMLU KOYYATI AGE 52 AT. A 702 GREAT RESIDENCI C H C GHATKOPAR MANKUR
6.
Name of the Hospital to Which He/She Was Removed
:-
MGM Hospital Kalmboli new panvel
7.
Number Of Vehical and type Of the Vehical
:-
1) M H 46 Z 1673 , 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
:-
SATYANARAYAN RAMLU KOYYATI AGE 52 AT. A 702 GREAT RESIDENCI C H C GHATKOPAR MANKURD LINK ROAD INDIAN OIL COMPANY GONVANDI
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SATYANARAYAN RAMLU KOYYATI ,AT. A 702 GREAT RESIDENCI C H C GHATKOPAR MANKURD LINK ROAD INDIAN OIL COMPANY GONVANDI
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
:-
RASAYANI POLICE STATION MOTOR ACCIDENT NO 39/2017
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.