Here we will discuss about modal draft format of CLAIM PETITION UNDER SECTION 166/140 OF THE MOTOR VEHICLE ACT FOR GRANT OF COMPENSATION OF RS. 10,00,000/-.
IN THE HON’BLE COURT OF MOTOR ACCIDENT CLAIMS TRIBUNAL __
Sanjeet Kumar. ……..Petitioner
Versus
1. Prakash Kumar
(Driver of the offending vehicle
Bolero Camper/Delivery Van bearing its registration No. ________).
2. Dharam Chand
(Owner of the offending vehicle
Bolero Camper/Delivery Van bearing its registration No. _________).
3. United India Insurance Company Ltd., Branch Office at Old GT Road Oppo. ___________ through its manager (Insurer of the offending vehicle Bolero Camper/Delivery Van bearing its registration No. ________ vide policy No. _______ w.e.f. 18.11.2016 to 17.11.2017). …………Respondents
Petition under section 166/140 of Motor Vehicle Act for grant of compensation of Rs. 10,00,000/-
Respected Sir
The petitioner humbly submits as under:-
That the above named petitioner do here by apply for grant of compensation on account of injuries sustained by the petitioner in a motor vehicle accident caused by rash, negligent and reckless manner driving of the driver of offending vehicle Bolero Camper/Delivery Van bearing its registration No. ______ on dt. 24.11.2016, at about 12:00 p.m., at near ________, in the area of P.S. _________, U.P. The necessary particulars of the accident, place of occurrence are as under :-
|
1 |
Name and father name
of the Injured. |
Sanjeet Kumar son of Sh. ______ |
|
2 |
Full address of the
injured. |
|
|
3 |
Age of the injured. |
Approx. 23 years. |
|
4 |
Occupation of the
injured. |
Private Job |
|
5 |
Name & address of
the employer. |
|
|
6 |
Monthly income of the
injured. |
Rs. 15,000/- per month
|
|
7 |
Does the person in respect of whom compensation is claimed, pay
income tax. |
No
|
|
8 |
Place, date and time
of the accident |
The accident took
place on dt. 24.11.2016, at about 12:00 p.m., at near _______, in the area of
P.S. _______U.P.
|
|
9 |
Name & address of
the Police Station in whose jurisdiction accident took place |
P.S. _________. where
FIR No. ____ dated ______, u/s 279, 338, 427 IPC & 184 of MV Act, has
been lodged against respondent No. 1 and offending vehicle Bolero Camper/Delivery Van bearing
its registration No. _______. |
|
10 |
Was the person in
respect of whom the compensation is claimed, traveling in the offending
vehicle |
No |
|
11 |
Nature of injuries sustained
by injured. |
The injured sustained grievous
injuries as well as fractures and other parts of his body as described in discharge
summary which is attached herewith. |
|
12 |
Name and address of
the medical officer who attended the injured. |
M.O. of _____ Hospital,
_______ |
|
13 |
Registration No. and
type of vehicle involved in the accident. |
Bolero Camper/Delivery Van bearing
its registration No. ________. |
|
14 |
Name and address of
the owner of the offending vehicle |
Respondent No. 2 is
owner of the offending vehicle. |
|
15 |
Name and address of
the driver of the offending vehicle |
Respondent No.1 is
driver of the offending vehicle. |
|
16 |
Period of treatment
and expenditure if any incurred |
Firstly the petitioner
was admitted at _____ Hospital and thereafter admitted in ______ and after
that admitted in ________from 24.11.2016 to 30.11.2016 and now he is still
under treatment. The injured is still under treatment and an amount of Rs. 4,00,000/-
(Four Lakhs only) has so far been spent on his treatment, conveyance,
attendants and special diet and more amount is likely to be increased as the
injured is still under treatment. |
|
17 |
Name and address of
the insurer of the offending vehicle |
Respondent No. 3 is insurer
of the offending vehicle. |
|
18 |
Has any claim been
lodged with the owner/insurer if so with what result |
No. |
|
19 |
Relationship with the
injured person. |
Self. |
|
20 |
Name and address of
the petitioner/ claimant |
As mentioned in the
title of the petition |
|
21 |
Title of the property
of the injured. |
Self. |
|
22 |
Amount of compensation. |
Rs.10,00,000/-(Rupees Ten
Lakhs) |
23. Any other information that may be helpful or
necessary in the disposal of the claim petition.
(I). That, prior to this accident, the injured was a strong and
healthy person of 23 years of age and because of the injuries sustained in the
accident, he has suffered great mental pain and agony. The petitioner was
working as HR Coordinator at ____________ and he was earning Rs. 15,000/- per
month. The petitioner has also sustained grievous injuries upon his entire body
as per discharge summary and after this accident, the petitioner is not able to
do his work continuously and he has also become unable to walk properly and has
become a disabled person due to the injuries sustained in the accident. The
petitioner is also under treatment now. The petitioner and his family members
have suffered a great loss because of the injuries sustained by the petitioner
in the said accident. The petitioner has spent an amount of Rs. 4,00,000/-
approx. on his treatment, medicines, special diet & conveyance etc. and
more amount is likely to be spent upon the treatment of the petitioner. The
petitioner was only bread-earner in his family and all family members totally
depend upon the income of the petitioner and the petitioner is not able to
achieve the goal of his life and his future has become dark due to the injuries
sustained in the accident. This accident was the sole result of reckless, rash
and negligent driving of the respondent no. 1 who is solely responsible for the
said accident.
(II) That the present
accident was caused due to the rash and negligent, careless, reckless and
excessive speedy driving of the respondent No.1 as at the time of accident he
was driving the offending vehicle make Bolero Camper/Delivery Van
bearing its registration No. ___________rashly,
negligently, carelessly, recklessly and at a very high speed. So the respondent
No.1 is the sole responsible for the present mis-happening/accident.
(III) That the petitioner has claimed an amount of Rs. 10,00,000/-
(Rupees Ten Lakhs only) on account of injuries sustained by him in the
accident, expenditures incurred by him upon the treatment, future loss of
income and on account of pain and suffering of the injuries.
Brief description of the accident:-
That on 24.11.2016, the petitioner was coming from _______to his village by a motorcycle bearing its registration No. ________ and at about 12:00 p.m. in day, when he reached at _______ in the meantime the offending vehicle Bolero bearing registration No. ________ came from front side/wrong side which was being driven by its driver/respondent No. 1 in a very high speed, rash, reckless and negligent manner and hit the motorcycle of petitioner as a result of which the petitioner sustained grievous injuries on his body as described in discharge summary and __________ are eye witness of the said accident and they with the help of police got admitted the petitioner in ___________from where he was referred to ______________ and lateron he was admitted in ________ due to serious condition. This accident was happened/caused due to the sole negligence manner of respondent no.1. The matter was reported to the police of P.S. ______, where F.I.R No. _________, u/s 279, 338, 427 IPC & 184 of MV Act was lodged against the respondent No. 1 on the statement of ____________.
24. Whether the petition is :Yes within time.
Prayer-
It is therefore prayed that the petition may
kindly be accepted with cost and an award of Rs. 10,00,000/- (Rupees Ten Lakhs
only) may kindly be passed in favour of the petitioner and against the
respondents jointly and severally with cost of the petition along with interest
at the rate of 18% per annum from the date of filing the petition till the
realization of the amount in the interest of justice.
And any other relief, which this Hon’ble tribunal deems fit and proper may also be granted to the petitioner as compensated, in the larger interest of justice.
Petitioner.
Sanjeet Kumar
Verification-It is
verified that the contents of this petition are true and correct to the best of
my knowledge and belief. Verified at _____
Through Counsel :-
(Affidavit in support of Claim petition)
Before the Motor Accident Claim Tribunal
Sanjeet Kumar Versus Parkash Kumar and others
Claim petition under MV Act
Affidavit
I, _______________, do hereby solemnly affirm and declare as under:
1- That the above noted claim petition has been filed by the deponent along with other petitioner and all the contents of the petition has been fully read over and explained to us by our counsel in simple Hindi which the deponent accept to be correct and true.
Verified :That the above contents of this affidavit are correct and true to the best of my knowledge and belief and nothing has been concealed therein. Verified at
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