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Application for Payment of Compensation under Section 140 and 166 of Motor Vehicles Act, 1988 for claiming motor accident compensation before the Motor Accident Claims Tribunal.

Format of Claim Petition to be filed before the Motor Accident Claims Tribunal to claim Motor Accident Compensation by the victim or family or dependent.

Application before the Motor Accidents Claims Tribunal should be filed with all the documents like normal Petition and with the below given application form. The Petition should include:

1. Memo of Parties

2. Application under Section 140 and 166 of the Motor Vehicles Act 1988 for grant of compensation along with affidavit in Support.

3. List of documents with documents

4. Vakalatnama

Format of Application under Section 140 and 160 of Motor Vehciles Act, 1988 is given below:

 

 

BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL_________

CLAIM PETITION NO. __________ OF 20__
 

IN THE MATTER OF:

Mr. _________                                                            CLAIMANT
New Delhi

VERSUS


1. Mr. ____________                                                    RESPONDENT NO.1
                                                                                    (DRIVER)


2. Mr. ____________                                                    RESPONDENT NO.2
                                                                                    (OWNER)

3. ______________ Insurance Company Ltd                RESPONDENT NO.2
                                                                                    (INSURANCE COMPANY)
 

POLICE STATION: _______________

APPLICATION FOR PAYMENT OF COMPENSATION UNDER SECTION 140 AND 166 OF MOTOR VEHICLES ACT, 1988


 

1. Name and Father's Name of the Person injured Mr. _______________ s/o Mr. ______
2. Full address of the Person injured  
3. Age of the Person injured  
4. Occupation of the Person injured  
5. Name & Address of the Employer of the injured  
6. Monthly Income of the person injured  
7. Does the person in respect of whom compensation is claimed pay income tax? If so state the amount of income tax  
8. Place, date and time of accident  
9. Brief particulars of the accident  
10. Name and address of the Police station in whose jurisdiction accident took place or was registered  
11. Was the person in respect of whom compensation is claimed traveling by the vehicle involved in the accident? If so give the name and place of starting the journey and destination  
12. Nature of Injuries sustained and disablement, if any, caused  
13. Name and address of the Medical Officer/ Practitioner, if any who attended the injuries  
14. Period of treatment and expenditure if any incurred  
15. Registration Number and type of vehicle involved in the Accident  
16. Name and Address of the owner of the vehicle  
17. Name and address of Driver of the Offending Vehicle  
18. Name and address of the insurer of the vehicle  
19. Has any claim been lodged with the owner, insure if so, by the Applicant with what result  
20. Name and Address of the Applicant  
21. Relationship with diseased  
22. Title of the Property of the deceased  
23. Amount of Compensation claimed and basis thereof e.g. Pecuniary loss of earning, Medical Expenses, Loss on account of Mental agony etc..
24. Whether reports from the police and Registering Authority have been obtained in Form "A" and Form "D" (If so, to be annexed)  
25. Whether affidavit of the Applicant and witnesses as per rule 8 are annexed (give details)  
26. Whether documents mentioned in Rule 8 are being annexed duly indexed (give details)  
27. Any other information that may be necessary and helpful in the disposal of the case  

  

 

 

PART II

(To be filled if prayer is made for interim award)

 

28. Amount of compensation claimed as interim award  
29. Reason for claim of interim award e.g. claimant is bedridden etc
30. Whether documents mentioned in sub-rule (4) and sub-rule (5) of rule 20 have been annexed (give details)  
31. Prayer e.g. It is therefore most respectfully prayed that the Petitioner may be awarded a compensation of Rs. ; and

If is further, most respectfully prayed that the Claimants may be awarded compensation under Section 140 of the Motor Vehicles Act, 1988.

Any other or further relief as this Hon'ble Tribunal may deem fit and proper in the facts and circumstances of the case as may be made.

 

PETITIONER

THROUGH

______________., Advocate

Place :

Date :

VERIFICATION

I, ____________, the above named claimant do hereby verify that the contents of Para 1 to 31 of the Claim Petition are true and correct to the best of my knowledge and belief and those of legal averments are true and correct on the basis of legal advice received and believed to be true by me. The last para is the prayer to this Hon'ble Tribunal

Verified at ____ on this ______ day of _____ 20__
 

PETITIONER

 

BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL_________

CLAIM PETITION NO. __________ OF 20__
 

IN THE MATTER OF:

Mr. _________                                                                        PETITIONER
 

VERSUS

Mr. ____________ & ORS                                                    RESPONDENTS

AFFIDAVIT

I, _______, the above named Deponent do hereby solemnly affirm and state as under:

1. That I am the Claimant herein and as such am well conversant with the facts and circumstances of the present case and hence am competent to swear this Affidavit.

2. That the statement of facts accompanying Claim Petition has been drafted under my instructions and the contents thereof, except the legal averments contained therein, are true and correct to the best of my knowledge and belief. The legal averments contained therein are true and correct on the basis of the legal advice received by me and believed by me to be true tree and correct. The contents of the Petition not being repeated over here for the sake of brevity and to avoid prolixity.

3. That the deponent declares that no such claim, either before this Hon'ble Tribunal or any other Tribunal or any other Court has been preferred by the Claimants either in Delhi or at any other place.

4. That the Deponent had never been involved in any earlier road accident and no tribunal had ever granted/ made liable, for any compensation arising out of any motor vehicle accident.

5. That no part of this affidavit is false and no materials facts have been concealed therefrom.

DEPONENT

I, __________, the above named Deponent, do hereby verify that the contents of the Present affidavit are true and correct to the best of my knowledge and belief, and no part of it is false and no material facts have been concealed therefrom.

Verified at _________ on this ___ day of ____ 20__

DEPONENT

BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL_________

CLAIM PETITION NO. __________ OF 20__
 

IN THE MATTER OF:

Mr. _________                                                                        PETITIONER
 

VERSUS

Mr. ____________ & ORS                                                    RESPONDENTS

LIST OF DOCUMENTS WITH DOCUMENTS

S. NO PARTICULARS PAGE NO
1. Copy of FIR  
2. Copy of Medical Record dated ____  
3. Copy of Aadhar Card of Petitioner  
4. Copy of PAN Card of Petitioner  
5. Copy of Driving License of Petitioner  
6. Copy of Medical Bills  
7. Copy of Income Tax Returns of Petitioner  
8. Copy of Insurance Certificate of Respondent No. 2 issued by Respondent No. 3  
9. A table showing Petitioner's Medical Expenses as on ________  
10. Brief Particulars of the Accident  

THROUGH

______________., Advocate

Place :

Date :

 

Download format of Application under Section 140 and 166 of Motor Vehicles Act 1988 in MS Word format to file claim before Motor Accident Claims Tribunal

 

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