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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.
:-
MANGAON POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
MOTOR ACCIDENT NO 26/2018
4.
Date,Time And Place Of Accident
:-
2018-05-22 , 14:48 , AT. MANGAON TAMHANI GHAT TURN
5.
Name of Injured/Deceased
:-
NAME OF INJURED - 1) SURESH JAYSHING DHAYAGUDE AT. SAKHARLWADI TALUKA FALTAN DISTRICT SATARA 2) M
6.
Name of the Hospital to Which He/She Was Removed
:-
SUB DIVISIONAL HOSPITAL MANGAON TAL MANGAON DIST RAIGAD
7.
Number Of Vehical and type Of the Vehical
:-
1)M H 11 B V 3897 2) M H 26 AA 0990 , 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
:-
SURESH JAYSHING DHAYAGUDE AT. SAKHARLWADI TALUKA FALTAN DISTRICT SATARA
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
SURESH JAYSHING DHAYAGUDE, AT. SAKHARLWADI TALUKA FALTAN 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
:-
MANGAON POLICE STATION MOTOR ACCEDENT NO 26/2018
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.