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 : ______ 


 [CD1]MOTOR VEHICLE COMPENSATION