Motor Accident Claims

Before the Motor Accidents Claims Tribunal, Chennai
O.P. No._______________ of 20______
___________________________________ … Petitioner
Versus
____________________________________ … Respondent
Petition u/s 166, 140/142 of M.V.Act and

Rule 3 of M.A.C.T. Rules
Necessary particulars in respect of Injured / Deceased and vehicle, are given below:
1. Name and father’s name of the person

injured / deceased
2. Full address of the person injured /

deceased
3. Age of the person injured / deceased
4. Occupation of the person injured / deceased
5. Name and address of the employer if any of

the injured / deceased
6. Monthly income of the person injured /

deceased
7. Does the person in respect of whom

compensation is claimed pay income tax? If
so, state the amount of income tax (to be
supported by documentary evidence)
8. Place, date and time of the accident
9. Name and address of the Police Station in

whose jurisdiction the accident took place or
was registered
10. Whether the person in respect of whom

compensation is claimed travelling by the
vehicle, involved in the accident. If so, give
the names of places of starting of journey
and destination.
11. Nature of injuries sustained
12. Details of the damages caused to the

property on account of the accident
13. Name and address of the Medical Officer /

Practitioner, if any who attended on the
injured / deceased
14. Period of treatment and expenditure, if any,

incurred thereon
15. Disability for work, if any, caused
16. Registration Number and type of the vehicle
17. Name and address of the owner of the

vehicle
18. Name and address of the insurer

19. Name and address of the driver in charge of
the vehicle at the time of accident
20. Was any claim been lodged with the

owner/injurer, if so with what result?
21. Name and address of the Applicant
22. Nature of relationship with the deceased
23. Title to the property of the deceased
24. Amount of compensation claimed
25. Particulars of loss and expenses

PART-I
(a) Loss of earning from………………. Rs.
To …………………………..
(b) Partial loss of earnings from……….. Rs.
to ……………………………
(c) At the net rate of Rs. Rs.
(d) Transport to Hospital Rs.
(e) Extra nourishment Rs.
(f) Damage to clothing and articles Rs.
(g) Others Rs.
PART-II
(h) Compensation for pain and suffering Rs.
(i) Compensation for continuing of Rs.
permanent disability, if any
(j) Compensation for the loss of earning Rs.
member
TOTAL Rs.
26. Whether the application is not made within
six months of the occurrence of the
accident, the cause thereof
27. (i) Whether the injured / deceased has been

involved in any other Road accident earlier
(if yes, give details)
(ii) Whether the injured / deceased has

preferred a claim for damages in any case
earlier and if so with what result?
(iii) Whether the injured / deceased is

related to or is known to the owner of the
vehicle and if so how?
28. Any other information that may be

necessary or helpful in the disposal of this
claim. Here furnish a brief account of how
the accident occurred and state how the
applicant is entitled to claim compensation
and how the Respondents are liable to pay
compensation claimed?
31. State how the Respondents are liable to pay

compensation to the petitioner?
Counsel for Petitioner Petitioner
VERIFICATION
I, ________________________________, do hereby declare that the facts and

particulars stated above are true and correct to the best of my/our knowledge and that I/we have
not claimed or obtained any compensation under the Workmen’s Compensation Act, 1923 so
far as this case is concerned.
Dated at Chennai on this the ______day of ________________ 20_____
Petitioner
THE MOTOR ACCIDENTS CLAIMS TRIBUNAL AT CHENNAI
O.P. No.____________________________ of 20_______
____________________________________________ … Plaintiff NOTE:
Versus Value of the Claim Rs.________________
Court Day __________________________

____________________________________________ … Defendant
Application made by above named Plaintiff / Defendant for issue of Process (and Deposit of Witness Batta, Etc.)
Nature of Subsistance allowance
Process Name and description of The Municipal Division or Travelling allowance for
Distance in
sought to be person on whom or on whose other place where the journey to and from the Class of Process Fees
miles from Amount For how many Remarks
issued with property, the process is sought process is to be served or Court house allowance Rs.
Court house Rs. days
section of to be issued or executed executed Rs.
law
(1) (2) (3) (4 (5) (6) (7) (8) (9) (10)
Dated at Chennai on this the ______ day of ______________________ 20__________

Counsel for ____________________
The Motor Accidents
Claims Tribunal at
Chennai
O.P. No___________ of 20____
_______________________________________
… Plaintiff
Versus
_______________________________________
… Defendant
PROCESS APPLICATION
_______________________________________
Counsel for Plaintiff / Defendant
Before the Motor Accident Claims Tribunal at Chennai
O.P. No._______________ of 20______
M.P. No._______________ of 20______
___________________________________ … Petitioner
Versus
____________________________________ … 1st Respondent
____________________________________ … 2nd Respondent
To
WHEREAS the above named petitioner has made an application to this Court under
section 166 of Motor Vehicles Act.
You are hereby warned to appear in this Court in person or by a pleader duly instructed
on the ______day of ________________ 20_____ at 10.15 a.m. in the forenoon to show cause
against the application failing which the said application will be heard and determined exparte.
GIVEN under my hand and the seal of the Court, this the ______day of _____________ 20____

Motor Accident Claims

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Before the Motor Accidents Claims Tribunal, Chennai

O.P. No._______________ of 20______

Petition u/s 166, 140/142 of M.V.Act and

1. Name and father’s name of the person

2. Full address of the person injured /

3. Age of the person injured / deceased

4. Occupation of the person injured / deceased

5. Name and address of the employer if any of

6. Monthly income of the person injured /

7. Does the person in respect of whom

9. Name and address of the Police Station in

10. Whether the person in respect of whom

11. Nature of injuries sustained

12. Details of the damages caused to the

13. Name and address of the Medical Officer /

14. Period of treatment and expenditure, if any,

15. Disability for work, if any, caused

16. Registration Number and type of the vehicle

17. Name and address of the owner of the

18. Name and address of the insurer

20. Was any claim been lodged with the

21. Name and address of the Applicant

22. Nature of relationship with the deceased

23. Title to the property of the deceased

24. Amount of compensation claimed

25. Particulars of loss and expenses

27. (i) Whether the injured / deceased has been

(ii) Whether the injured / deceased has

(iii) Whether the injured / deceased is

28. Any other information that may be

31. State how the Respondents are liable to pay

Counsel for Petitioner Petitioner

I, ________________________________, do hereby declare that the facts and

Dated at Chennai on this the ______day of ________________ 20_____

____________________________________________ … Plaintiff NOTE:

Versus Value of the Claim Rs.________________

Court Day __________________________

Dated at Chennai on this the ______ day of ______________________ 20__________

O.P. No___________ of 20____

O.P. No._______________ of 20______

M.P. No._______________ of 20______

____________________________________ … 1st Respondent

____________________________________ … 2nd Respondent

section 166 of Motor Vehicles Act.

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O.P. No._________ of 20

Dated at Chennai on this the day of ______ 20_

Dated at Chennai on this the day of ______ 20

O.P. No_______ of 20

O.P. No._________ of 20

M.P. No._________ of 20