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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.
:-
KHOPOLI POLICE STATION
2.
CR No.
:-
---
3.
Accident No.
:-
MOTOR ACCIDENT NO 66/2018
4.
Date,Time And Place Of Accident
:-
2018-06-05 , 06:30 , At. Mumbai To Pune High Way Road Dasturi Gaon 44 k m
5.
Name of Injured/Deceased
:-
NAME OF INJURED - NIL
6.
Name of the Hospital to Which He/She Was Removed
:-
NIL
7.
Number Of Vehical and type Of the Vehical
:-
M H 04 H D 3909 , 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
:-
Prathamesh Vithal Kadam At. IndaraNagar Taluka Pen Mul At. Landagewadi Taluka Kavathemhakal District Sagali
9.
Name And Address Of the Owner Of the Vehical As It Stand On the Date Of Accident
:-
Ravindra Shankar Dubale ,At,. Bhaidar Thane
10.
Name And Address Of the Insurance Company With Whome the Vehical Was Insured And the Divisional Office Of the Said Insurance Company.
:-
reliance general insurance company , H Block, 1st Floor Dhirubhai Ambani Knowledge City, Navi Mumbai 400 710. , Navi Mumbai
11.
Number Of Insurance Policy/Insurance Certificate And the Date Of Validity Of the Insurance Policy/Insurance Certificate.
:-
11052/18233/40000396,2019-01-05 , 2018-01-06
12.
Action Taken, If Any, And the Result thereof
:-
KHOPOLI POLICE STATION MOTOR ACCIDENT NO 66/2018
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.