MOTOR VEHICLE COMPENSATION [CD1]
IN
THE COURT OF MOTOR ACCIDENT CLAIMS TRIBUNAL AT ……………………
MAC No:_____________ of
20………….…..
…………………………………………………………………………………..Petitioner
Versus
…………………………………………………………………………………..Respondents
Petition Under Section 166 of the
Motor Vehicles Act for the Grant of Compensation to the Petitioner on Account
of Damage to his _________
Respectfully Sheweth:
I,
The above named petitioner, do hereby apply for the grant of compensation
loss/damage sustained to my property described as _____ by use of Motor Vehicle
of the respondent No. ______. The necessary particulars of the _____ in
question are given as under:-
1.
Name
and father's name of the claimant: Same as given in memo of parties above.
2.
Full
address of the property: Resident of : _______
3.
Age
of the injured: _______ Years.
4.
Occupation
of the injured: _______ presently
5.
Name
and address of the deceased/injured : Resident: _______
6.
Did
the person in whose respect compensation is claimed pay income tax :
______-_Yes/No
7.
Monthly
income :Rs. _______
8.
Place,
date and time of accident : Accident took place at _______
9.
Name
of police station : PS : _______
10.
Was
the person in whose respect the compensation is claimed traveling in the bus
and if so than the place of start of journey & destination: The person in
whose respect the compensation is being claimed was traveling in the _______
11.
Nature
of the loss/injury sustained by
the property:
The _______
12.
Name
and address of the person
who attended/visited the property: _______
13.
Period
of treatment and expenditure: The injured/deceased remained under treatment
from _______
14.
Registration
and type of vehicle involved
in the
accident:
Regn No. _______
15.
Name
of the insurer: Not known. _______
16.
Has
any claim been lodged with the insurer : _________Not known.
17.
Name
and address of the owner of the vehicles: Same as given in memo of parties
above.
18.
Name
and address of the applicant:
Same as
given in memo of parties
above.
19.
Relation
with the deceased/injured : The petitioner _______
20.
Title
to the property : The _______
21.
Amount
of compensation: - Injury _______ - Love & Affection _______ - Medical
Expenses _______
Images
_______ - Pain & mental Agonies _______ - Loss of Marital Bliss _______
Total ______________
22.
Any
other information which may be necessary for the disposal of the claim: The
________
23.
Reasons
or grounds for late submission of claim application on which condonation of
delay is claimed. The claim application is within the period of
limitation.
24.
Cause
of Accident with brief description : The accident took place due to rash and
negligent driving of the driver of the vehicle. __ It is, therefore,
respectfully prayed that the petition may kindly be allowed and the petitioner
may kindly be awarded compensation amounting to Rs. _________ as ________ and
interest thereon @18% per annum till payment against all the respondents
jointly and severally.
…………………………………..
Petitioner
______________
Through, Advocate
Verification:
I,
the above named deponent do hereby verify that the contents of this affidavit
of mine are true and correct to the best of my knowledge and belief.
Verified at ……………….. this
the -- day of ._______ Petitioner
IN THE COURT OF MOTOR ACCIDENTS CLAIMS
TRIBUNAL AT …………………………
………………………………………………………………Petitioner
Versus
……………………………………………………….……Respondents
Application
Under Section 140 of The Motor Vehicles Act For Compensation On Account Of No
Fault
Liability
Respectfully Sheweth :
1.
That
the petitioner hereinabove has filed an application under the Motor Vehicle Act
in this Hon'ble Court, hearing/final disposal whereof will take some time.
2.
That
it is apparent from perusal of grounds and documents attached therewith that
the petitioner has prima facie a very good case in his favour and the petition
is bound to succeed.
3.
That
the balance of convenience is clearly in favour of making of an interim order
granting a sum of Rs. ……………………..- on account of No Fault Liability to the
petitioner pending disposal of the petition.
4.
That
interest of justice demands that the respondents are directed to deposit and
pay a sum of Rs. …………………………- to the petitioner as admittedly the
______________death/permanent disablement has been occasioned by the use of the
vehicle of the respondents and the same is amply evident from the perusal of
grounds of petition and the documents attached therewith.
5.
It
is, therefore, most humbly prayed that this application may kindly be allowed
and the respondents be directed to deposit and pay a sum of Rs. ………………..… to
the petitioner under the Act on account of No Fault Liability in interest of
justice.
FOR
THIS ACT OF KINDNESS, THE HUMBLE APPLICANT AS IN DUTY BOUND, SHALL EVER
PRAY.
……………………….
Petitioner
______
Through, Advocate
IN
THE COURT OF MOTOR ACCIDENTS CLAIMS TRIBUNAL
AT
…………………………
MAC No.: ______ of 20……..
…………………………………………………………………..Petitioner
Versus
………………………………………………………..Respondents
Affidavit in support of
Application under Section 140 of the Motor Vehicles Act
I,_____________, do hereby
solemnly affirm and declare as under :-
1.
That
the accompanying
application has been prepared under
my instructions.
2.
That
the contents of paras 1 to 5 of the accompanying application are correct and
true to the best of my knowledge.
3.
That
I further solemnly affirm and declare that this affidavit of mine is correct
and true, no part of it is false and nothing material has been concealed
therein.
Affirmed at ……………………………..
this the ______.
Deponent
In the above noted suit every summons,
notice & other order may be served on me on the address given above during
the pendency of the suit. Change of Address will be intimated to the
Court.
Dated : ______
Plaintiff/Petitioner
Defendant/Respdt
Through, Advocate
PROCESS FEE
In the Court of : Motor Accidents Claims Tribunal
at…………………..
…………………………………………………………………………….
Versus
……………………………………………………………………………..
Claim : Accident
Claim______
Petitioner For the service
of respondents:-
Advocate
Received on
__________________ Court-fee stamp of the value of Rs. ______________ with
___________ ____ copies
in case No. __ of 20………
………………………………………………………………………….
Vs
………………………………………………………………………
Signature of the Head
Notice Writer
Under Order 7 Rule 13 (1)
CPC
List of documents filed by
Plaintiff
In the Court of : Motor
Accidents Claims Tribunal at Coimbatore
…………………………………………………………………………….
Versus
………………………………………………………………………………..
Date Of Hearing: ______
Suit for : Claim
Date of Production :______
S.No
Details, Date What is If documents If Rejected Documents Intended Filed what is
then the to be the
Exh marked date of Proved
from on
it return
of Documents
To prove petitioner's
case
1. FIR
2. Postmortem Report
______
3. School Leaving Certificate
______
4. Income Certificate
______
Date:
______
Counsel
for Plaintiff/Defendant
List of Document Relied
Upon
Under Order 7 Rule 14 CPC
Filed by : ______
In the Court of : Motor
Accidents Claims Tribunal
at………………………………
…………………………………………………………………..
Versus
……………………………………………………………..
Suit
: Claim Petition Date of hearing:
----------------------------------------------------------------
1.
Have
you produced any Yes Sir, as per list. documents with the plaint so, what are
those document.
2.
Do
you wish to produce any more Yes sir, if required. documents which are in your
possession and custody if so, what are those documents.
3.
Do
wish to relay upon any Yes sir, later on from other documents, if so in various
authorities.
whose
possession they are and what are those documents.
-----------------------------------------------------------
Counsel for Dated :
______
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