model format of undertaking affidavit to be filed along with motor accidents claims petition

   MODEL FORMAT OF UNDERTAKING AFFIDAVIT TO BE FILED ALONG WITH MOTOR                                                          ACCIDENTS CLAIMS PETITION

BEFORE THE MOTOR ACCIDENTS CLAIMS TRIBUNAL,

COURT

PLACE.

MCOP     /  22.

Name of the petitioner                          ---             Petitioner/1^st claimant.

                                                                VS

Name of the Respondent                        ---         Respondents/Respondents.

AFFIDAVIT

I,      W/O          aged      years, and residing at                          do hereby solemnly affirm and sincerely state as follows:

1.     I am the petitioner and the 1^st claimant herein.

2.    I have filed a claim petition for the grant of compensation on the death of my husband----- who met with motor vehicle accident.

3.    As I know that the accidental vehicle involved in accident was insured at  the time of accident. I along with other claimants propose to file the claim petition  before this hon’ble  tribunal claiming compensation. As such I have met the Advocate and instructed to file  the claim petition on behalf of me. I herewith undertake that I have not prepared  any other claim petition seeking compensation before any tribunal  or forum regarding  this accident.

 

     For those effects I swear and sign this affidavit

   Petitioner / claimant.

Solemnly affirmed and Signed before me at -------                              

 

 

 

 

BEFORE THE MOTOR

ACCIDENTS CLAIMS

TRIBUNAL, COURT,

PLACE.

 

MCOP       /22.

 

Name of the petitioner

--- Petitioner/1^st claimant.

 

---------

Affidavit

---------

Name of the respondent

--- Respondent / Respondent.

 

                                                                                                    By

Name of the Advocate

Place.