Vinod V Ranjeet Singh
Vinod V Ranjeet Singh
Vinod V Ranjeet Singh
MACT,
VERSUS
INDEX
New Delhi
Date: PETITIONER
THROUGH
VERSUS
MEMO OF PARTIES
VERSUS
New Delhi
Date: PETITIONER
THROUGH
VERSUS
VERSUS
Sir,
PART-I
1. Name & father’s Name of the Ratiram S/O Sukh
person injured/dead (Husband Ram
Name in case of married Women
& Widow)
2. Full Address of the person R/O Sikri, Post
injured/dead Kumhera,Kiratpur,
Kiratpur, Bijnor,Uttar
Pradesh-246731.
3. Age of the person injured/dead 50 Years
4. Occupation of the person Labour
injured/dead
5. Name and address of the NA
employer of the employer of the
injured/dead
6. Monthly income of the person Rs.15,000/-
injured/dead
7. Does the person in respect of NO
whom compensation is claimed
pay income tax? If so state the
amount of the Income tax to be
supported by document)
8. Place, date and time of accident On 18.05.2019, At
about 09.30 P.M.,
Near Village-
Hassupura, Distt-
Bijnour
9. Brief particulars of the accident On 18.05.2019, the
deceased namely
Rati Ram along
with his brother
Raja Pal was
returning from
Muradabad to
Hassupura Bijnour
in a vehilce bearing
Registration No.
UP-20AW-8294
after attending
“Lagan Ceromony”
of his daughter. At
about 09.30 P.M.
when they reached
Hassupura,
suddenly the
offending vehicle
bearing
Registration No.UP-
20B-K005 coming
from the front side
in a rash and
negligent mannner
with a high speed
hit the vehilce in
which the deceased
was travelling and
due to the forceful
impact of the
offeding vehilce,
the deceased (since
then) died on way
to the hospital and
the vehicle was
destroyed.
10 Name and address of police P.S. – Noorpur, FIR
. Station in whose jurisdiction the No.179/2019 dated
accident took place was 19.05.2019 U/S
registered 279/304A/338/427.
11 `Was the person in respect of No.
. whom compensation is claimed
travelling by the Vehicle involved
in the accident? If so, give the
name and place of the starting
journey and destination
12 Name of the injuries sustained Fatal Injury
. and disabled, if any caused
13 Name and address of the Medical As Per Medical
. officer/Practitioner. If any who Papers
attended on the injuries
14 Period and treatment and As Per Medical
. expenditure if any incurred Papers
15 Registration No. and types of Offending vehicle
. vehicle involved in the accident Bearing
Registration No.
UP-20B-K005.
16 Name and address of the owner
Respondent No.1
. of the offending vehicle
17 Name and address of the driver
Respondent No.1
. of the offending vehicle
18 Name and address of the insurer Respondent No.2
. of the offending vehicle
19 Has Any Claim been lodged with No
. owner/insurer if so, with result?
20 Name and address of the As per the title of
. Applicant the petition
21 Relationship with the Wife
. deceased/injured
22 Title of the Property of the NA
. deceased/injured
23 Amount of Compensation claimed 30,00,000/- (Thirty
. Lacs Only)
24 Whether Reports from the police The Report in Form
. and registering authority have –A and D along
been obtained in Form –A and with FIR might
Form –D, if so, whether annexed: have been sent to
the Hon’ble
Tribunal by the IO
of the case which is
already pending.
25 Whether affidavit of the applicant Yes
. in Rule 8 are being annexed duly
indexed (give details)
26 Whether documents maintained Yes
. in Rule 8 are being annexed duly
indexed (give details)
27 Any other information that may NA
. be necessary and helpful in the
disposal of the case
PART-II
PRAYER
It is, therefore, most humbly prayed that this Hon’ble
tribunal may kindly be pleased to award compensation of Rs. 30,
00,000/- (Rs. Thirty Lacs only in favour of the Petitioner and against
the Respondents.
It is prayed accordingly.
New Delhi
Date: PETITIONER
THROUGH
VERIFICATION: