In the Court of Motor Accident Claims Tribunal (DJ), Place
Motor Accident Claim No. _____ OF 2020
A, son of X, caste ______ , resident of ______ , _______ occupation ______, aged 50 years …….…Plaintiff
B, son of Y, caste ______ , resident of ______ , _______ , occupation ________ , aged 40 years ……Defendant
The plaintiff above-named begs to state as under—
1. That the plaintiff is a foreman in the service of the Leader Press, Prayagraj.
2. The defendant No. 1 is the owner of car No. U.P.70 0772.
3. That on the 10th April, 2020,- while the plaintiff was returning to his house from the Press at about 6 in the evening and was near the Purshottam Dass Park, defendant who was driving the car rashly, took a wrong turn towards the right and in so doing knocked the plaintiff down and overran him by his car.
4. That In consequence of this accident the plaintiff sustained serious injuries in as much as he got severe bruises in his right leg and two of his teeth were knocked off. Besides these, there were four contusions on different parts on his body. All this necessitated his stay in the hospital for a month.
5. That the plaintiff has, as a result of the injuries, been permanently incapacitated and has been put to great expense in his treatment. He has had to absent himself from duty on account of these injuries from the 11th of April for which he has lost his salary.
6. That the cause of action for the suit arose on the 10th of April, 2020, when the accident took place.
7. That the accident took place at _______ within the jurisdiction of the court.
8. That the valuation of the suit for purposes of jurisdiction and court-fee is Rs, 840.
The plaintiff, therefore, prays:
1. That a decree for Rs. 840 be awarded to him Particulars of Special Damages
Expenses on account of medicine Rs. 100
Room rent in the hospital for 30 days Rs. 90
Food and extra nourishment Rs. 100
Loss of salary for two and a half months Rs. 250
General Damages Rs. 300
Total Rs. 840
2. That interest pendente lie and future be awarded to him.
I, the plaintiff above named do hereby verify that the contents of this plaint from paragraph 1 to 5 are true and correct to my personal knowledge and paragraphs 6 to 8 are believed to be true and correct according to the legal advice received to me.
Signed and verified on June 30, 2020 at _______ .
(Sd A Plaintiff)
(Sd. __________ ),