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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.
:-
KHALAPUR POLICE STATION
2.
CR No.
:-
MOTOR ACCIDETN CR NO 48/2018
3.
Accident No.
:-
--
4.
Date,Time And Place Of Accident
:-
2018-05-15 , 4:00 , AT. MANDAP GAON KM 26 TALUKA KHALAPUR
5.
Name of Injured/Deceased
:-
NAME OF DECEASED - VAIBHAV RAJARAM SHINDE AGE 23 AT. SINE KOLIWADA MUMBAI 37
6.
Name of the Hospital to Which He/She Was Removed
:-
PHC KHALAPUR TAL KHALAPUR DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1) MH 12 HD 4858 2) MH 11 AN 1398 , TEMPO
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
:-
1) GANESH RAJARAM SHINDE AGE 32 AT. SHINDE VASTI KUTHARE TALUKA PATHAN DISTRICT SATARA 2) DYANDEV NANA SHINDE AT. BARAMATI THAKANE TALUKA BARAMATI DISTRICT PUNE D L NO 04 19840001187
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
GANESH RAJARAM SHINDE,AT. SHINDE VASTI KUTHARE TALUKA PATHAN DISTRICT SATARA
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
:-
KHALAPUR POLICE STATION MOTOR ACCIDENT CR NO 86/2018
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.