Claim Petition No. _____ of _____ (to be filled in by the registry)
PETITION FOR COMPENSATION UNDER SECTION 166 OF THE MOTOR VEHICLES ACT, 1988
PETITIONER(S): __________
VERSUS
RESPONDENTS:
MOST RESPECTFULLY SHOWETH:
1. THE PETITIONER(S)
1.1 This petition is filed __________.
1.2 The injured or deceased person is __________, aged __________, __________, whose monthly income was __________.
2. THE ACCIDENT
3. THE INJURIES OR THE DEATH
4. LIABILITY OF THE RESPONDENTS
4.1 Respondent 1 was driving the vehicle. Respondent 2 is its registered owner and is liable for the acts of the driver. Respondent 3 had insured the vehicle on the date of the accident and is bound to satisfy any award. The Petitioner(s) say that the Respondents are liable jointly and severally.
5. THE COMPENSATION CLAIMED
5.2 The Petitioner(s) have not claimed compensation for this accident from any other court or tribunal.
6. JURISDICTION AND FILING
6.1 This Tribunal has jurisdiction because __________.
7. PRAYER
7.1 The Petitioner(s) pray that the Tribunal may be pleased to award them just compensation against the Respondents, jointly and severally, with interest from the date of this petition until payment.