BEFORE THE ACCIDENTS CLAIMS TRIBUNAL
Name of the court
Place
IA NO OF
20
IN
MCOP NO /20
Name
of the petitioner
--- Petitioner / 2nd respondent.
VS
Name
of the respondent ---- Respondent / petitioner.
AFFIDAVIT
I, , s/o , aged years, officer, ------ having it’s office at ------- do hereby solemnly affirm and sincerely state
as follows:-
1. I am an officer of the
petitioner insurance company, divisional office and I know the facts of the case. In the above claim, our insurance
company is the 2nd respondent
in the main petition.
2. The petitioners had filed
the claim petition for the grant of compensation on account of the injuries
sustained by him in a motor vehicle
accident.
3. This hon’ble court awarded
a sum of Rs. / along with
interest and cost on .
Accordingly, the petitioner/2nd respondent herein deposited a sum of
Rs. / and Rs. / totally Rs. / into the court.
4. The petitioner/2nd respondent had filed an appeal in CMA NO /20 on the file of the high court, on the ground that, the vehicle bearing regn.no. was
insured with this petitioner/2nd respondent with act only
policy and the insurance company is not liable to pay compensation. The appeal
is allowed and this petitioner / 2nd respondent is exonerated from
liability and permitted to withdraw the entire award amount with proportionate
accrued interest by filing necessary application and the Respondent / 1st
respondent is liable to pay the compensation amount. The amount of Rs. / along with accrued interest shall be
refunded to the petitioner / 2nd respondent insurance company. The
petitioner/2nd respondent is
entitled to withdraw the excess amount.
5. The invested amount is
send for from the bank as per order in IA NO
/ 2021 dated ---- . After send far now a sum of Rs. / is in C.C.D. The petitioner / 2nd
respondent is entitled to the said
amount.
6. Hence pay order to the
tune of Rs. / may be issued in favour of this
petitioner / 2nd respondent or else much loss and hardship will be
caused.
7. There is no attachment or
impediment over the above amount.
8. This petitioner/2nd
respondent undertake to redeposit the above said amount as and when required by
this hon’ble court.
9. In the above circumstances
in the interest of justice pay order may be issued for Rs. /in bank, place, account number
----------------------, MICR code -----------------,
IFSC code ---------------- in favour of the insurance co.ltd., and thus render
justice.
It is therefore just and
necessary that this hon’ble court may be pleased to issue a pay order For Rs. / and thus render justice.
Petitioner/2nd respondent.
Solemnly affirmed and signed before me
On this the day
of ,2021
At -----------.
Advocate.
BEFORE THE ACCIDENTS CLAIMS TRIBUNAL
Name of the court
Place
IA NO OF
20
IN
MCOP NO /20
Name
of the petitioner
--- Petitioner / 2nd respondent.
VS
Name
of the respondent ---- Respondent / petitioner.
PETITION ON BEHALF OF THE
PETITIONER UNDER SECTION 163 & 165 CPC
1.Address of the petitioner/2ND respondent:
-----------------
2.Address of the Respondents/claimants:
--------------------
For the reasons stated in
the accompanying affidavit, it is prayed that this hon’ble court may be pleased
to issue pay order for Rs. /in bank
, account number -----------------, MICR code ---------, IFSC code ---------------
in favour of the insurance co.ltd., and thus render justice.
Advocate for the
petitioner /2nd respondent.
BEFORE THE MOTOR ACCIDENTS
CLAIMS TRIBUNAL,
(NAME OF THE COURT)
PLACE.
IA NO OF 20
In
MCOP OF
20
Name of the petitioner.
Petitioner / 2nd respondent.
---------------------------------------------------
Petition on behalf of the
petitioner/
2nd respondent under
section 163 & 165 CPC
---------------------------------------------------
Name of the respondent.
-- Respondents/claimants.
BY
NAME.,
ADVOCATE,
PLACE
Encl
Affidavit 1.
BEFORE THE ACCIDENTS CLAIMS TRIBUNAL
Name of the court
Place
IA NO OF
20
IN
MCOP NO /20
Name
of the petitioner
--- Petitioner / 2nd respondent.
VS
Name of the respondent ---- Respondent / petitioner
Payment schedule.
--------------------------------------------------------------------------------------------------------
Particulars
of Name and
address of
Amount
the
amount the
amount receiver
--------------------------------------------------------------------------------------------------------
Balance
amount -------------- Rs. /
---------------------------------------------------------------------------------------------------------
Rs. /
---------------------------------------------------------------------------------------------------------
Prays
to grant payment
Petitioner/2nd
respondent
Received
a sum of Rupees (in words) only.
Petitioner/2nd
respondent. Advocate
for petitioner/2nd respondent.
BEFORE THE ACCIDENTS CLAIMS TRIBUNAL
Name of the court
Place
IA NO OF
20
IN
MCOP NO /20
Name
of the petitioner
--- Petitioner / 2nd respondent.
VS
Name
of the respondent ----
Respondent / petitioner
Full satisfaction memo
The claimant has received a
pay order for Rs. /- from
this hon’ble court towards the amount paid by petitioner/ 2nd
respondent in the above claim petition.
Full satisfaction may be recorded on
the part of the petitioner/2nd respondent.
Petitioner/2nd respondent Advocate for
petitioner/2nd respondent.
BEFORE THE ACCIDENTS CLAIMS TRIBUNAL
Name of the court
Place
IA NO OF
20
IN
MCOP NO /20
Name
of the petitioner
--- Petitioner / 2nd respondent.
VS
Name of the respondent ---- Respondent / petitioner
Receipt
Received a sum of Rs. /- (Rupees only) by way of pay order
towards appeal deposit amount along with interest in the above mentioned case
to the petitioner / 2nd respondent.
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