IN THE COURT OF MOTOR ACCIDENT CLAIM TRIBUNAL,

GURUGRAM, HARYANA

M.A.C.T. No. of 2024

IN THE MATTER OF:-

Sh. Rajesh & Ors. V/s Sh. Ramdev & Ors.

LIST OF DOCUMENTS

S.No.PARTICULARS. PAGES

1. Aadhar card of
petitioners

2. FIR

3. Treatment
Record and
Hospital Bills

4. Bank Account
details of
Petitioner No.1

5. Copy of
Insurance of
offending vehicle

GURUGRAM
DATED:

PETITIONERS
Rajesh, Mukesh, Balram

Through Counsel
Adv Gunjan Bhardwaj & Associates
 IN THE COURT OF MOTOR ACCIDENT CLAIM TRIBUNAL,
GURUGRAM, HARYANA

M.A.C.T. No. of 2024

IN THE MATTER OF:-

Sh. Rajesh & Ors. V/s Sh. Ramdev & Ors.

I N D E X

S.No.PARTICULARS. PAGES

6. Memo of parties.

7. Petition for grant

of Compensation.

8. Affidavits in
support Of the
petition of The
petitioner.

9. FIR, Treatment
Record and Bills,
Aadhar card of
petitioner and
pass book, copy of
Insurance
company of
offending vehicle

10. Vakalatnama.

11. Process Fee Form.

GURUGRAM
DATED:

PETITIONERS
Rajesh, Mukesh, Balram

Through Counsel
Adv Gunjan Bhardwaj & Associates
 IN THE COURT OF MOTOR ACCIDENT CLAIM TRIBUNAL,
GURUGRAM, HARYANA

M.A.C.T. No. of 2024

IN THE MATTER OF:-

Sh. Rajesh & Ors. V/s Sh. Ramdev & Ors.

MEMO OF PARTIES
1. Rajesh aged 44 years
S/o- Puriya
(Father of since deceased)
2. Mukesh aged 31 years
W/o – Rajesh
(Mother of since deceased)

3. Balram Gujar aged19 years

S/o- Rajesh
(Brother of since deceased)
All R/o- Chudla,Mundawar,
Hatoondi, Alwar, Rajasthan - 301427
…..Petitioners
Versus
1. Sh. Ramdev
S/o- Mahaveer
R/o – Kabariya, Baghera,
Ajmer, Rajasthan- 305415 ……Driver
2. Pa tel Mahesh kumar Bhikhabhai
S/ o-Bh ikhabha i
R/o -Upkha diya vas, Ghaghare t, V isnagar
Mehsana , Gu jarat -3 843 15 ….Owner
3. Mag ma HDI General Insurance Company limited.
SCO-386, 1st Floor, Sector 29,
Opposite IFFCO Chowk Metro Station,
Gurgaon – 122001 …Insurance Co
…Respondents.
GURUGRAM
DATED:
PETITIONERS
Rajesh, Mukesh, Balram

Through Counsel
Adv Gunjan Bhardwaj & Associates
 IN THE COURT OF MOTOR ACCIDENT CLAIM TRIBUNAL,
GURUGRAM, HARYANA

M.A.C.T. No. of 2024

IN THE MATTER OF:-

Sh. Rajesh & Ors. V/s Sh. Ramdev & Ors.

APPLICATION UNDER SECTION 166 & 140 OF THE

MOTOR VEHICLE ACT 1988 FOR GRANT OF
COMPENSATION

Sir,
The undersigned makes this application for grant of
compensation as per the provisions of the Motor Vehicles Act,
1988 on the basis of the following facts and information:-

1. Name & Father’s Name of Mintu S/o Rajesh

the person injured /dead
(Husband’s Name in
case of
married women & widow)
2. Full address of the Mintu (Deceased) S/o Rajesh
persons injured/ dead R/o- Gram Chudla, Post-
Hatundi, Alwar, Rajasthan-
301427
3. Age of the person 21 Years
injured/
dead.
4. Occupation of the person Care Taker cum Supervisor at
injured/ dead. construction site, and a farmer
5. Name & address of the Martand Infrastructure,
employer of the injured/ Proprietor- Akshya Loyal,
dead.
Jhunjhnu, Rajasthan
6. Monthly income of the Rs.30,000/- p.m from salary
person injured /dead. and 2,00,000 p.a from
farming (Agriculture)
7. Does the person in respect
of whom compensation is
claimed pay income Tax? NO
If so state the amount of
the income tax (to be
supported by document).

8. Place, date and time of NH- 48, Near Fozi Dhaba, Dated
accident. 21.11.2023, Approx 01.00 A.M.

9. Brief Particulars of the As per FIR. No. 305/023

accident U/s.279/337/304A IPC.
P o l i c e s t a t i o n - Manesar,
Distt. Gurugram,
Haryana. Copy of F.I.R
attached.
10. Name & Address of Police FIR. No. 305/023
Station in whose U/s.279/337/304A IPC.
jurisdiction the accident P o l i c e s t a t i o n - Manesar
took place or was , Distt. Gurugram,
registered. Haryana.
11. Was the person in respect No, The since deceased was
of whom compensation is on vehicle i.e. pickup
claimed traveling by the bearing no. RJ-32GC-5655
vehicle involved in the and was going from his
accident? If so, give the village Chudwa, Rajasthan
Name & place of starting to Azad pur Mandi, Delhi
the journey and to sell vegetables (Gajar)
destination. with other villagers.

12. Name of the injuries As per MLR, MLX and

sustained and disabled, if respective Medical Reports.
any, caused.
13. Name & Address of the Doctor Pawan, medical
Medical Officer/ officer, Prime Super
Practitioner if any who Specialty Hospital, Rewari
attended on the injuries. Brought dead in Medical and
health Department, Alwar,
Rajasthan.
14. Period of treatment and From 21.11.023 to 23.11 2023
expenditure. admitted in Prime Super
Specialty Hospital, Rewari
and petitioner has incurred a
sum of Rs 8,00,000 on his
treatment like M.R.I,medicine,
transportation, , hospitalization
, etc
15. Registration No. & type Offending vehicle Truck
of offending Vehicle bearing No. GJ- 02AT-
involved in 7670.
accident
16. Name & Address of owner Respondent No. 02,
of the offending Vehicle. As per title of the petition
17. Name & Address Of the Respondent No. 01,
driver of the offending As per title of the petition
Vehicle.

18. Name & Address of the Respondent No. 03,

insurer of the offending As per title of the petition
Vehicle.

19. Has any claim been

lodged with the NO
owner/insurer, If so,
with what result.
20. Name & Address of the As per title of the petition.
applicant.

21. Relationship with the Old age Father, Mother and

since deceased / injured. younger brother

22. Title of the property of No.

the since deceased
/injured.

23. Amount of the Rs. 70,00,000/- (Rs.

compensation claimed and seventy Lakh only) on the
basis thereof. basis of loss of earning,
past, future and present,
age, pain, agony, expenses,
conveyance, dependency
etc.
24. Whether reports from the
police and registering Copy of FIR attached.
authority have been
obtained in Form-A
and Form-D if so,
whether annexed.
25. Whether affidavit of the Yes, affidavit regarding not
applicant in Rule-8 are filing any similar claim
being annexed duly petition and regarding
indexed (give details) witness and
documents filed.
26. Whether documents
maintained in Rule-8 are FIR. attached.
being annexed duly
indexed (give details).

27. Any other information that may be necessary and

helpful in the disposal of the case.
27A. That on the unfortunate day of 21.11.023 the since
Deceased was going from his village Chudwa, Rajasthan to
Azad pur Mandi, Delhi to sell vegetables (Gajar) with other
villagers through pickup bearing no. RJ-32GC-5655. The
pickup bearing no. RJ-32GC-5655 was being driven by
Balak Ram S/o Lal Chand on his left hand side and in a
normal speed. He was obeying all the traffic rules. When
the concerned pickup bearing no. RJ-32GC-5655 reached
near fozi dhaba on NH 48 [delhi Jaipur highway] at about
01: 00 AM, the offending vehicle bearing no. GJ- 02AT-
7670 suddenly came in, it was driven in a very rash and
negligent manner and struck the pickup bearing no. RJ-
32GC-4302 from behind, as a result of which accident was
caused and the since deceased sustained multiple grave
and fatal injuries.
27-B Thereafter since deceased Sh. Mintu S/o Rajesh was taken
to Prime Super Specialty Hospital, Rewari , by the help of
member of general public hear the accident, where doctors of Prime
Super Specialty Hospital, Rewari started the treatment
but due to serious injury referred the case for superior
hospital for further treatment and during the shifting
from Prime Super Specialty Hospital, Rewari to other
hospital, his (Sh. Mintu) situation deteriorated and he was
declared dead by theh Doctor of Medical And health department
Alwar, Rajasthan.

27-C.That thereafter on the statement of Sh. Jagat singh

Gurjar an FIR.No. 305/2023 U/s.279,338, 304 -A of IPC.
was registered in P.S DLF PHASE II, Gurugram, Haryana
against the driver of the offending vehicle/respondent
No.1.

27-D.That the said accident was caused due to the sole

negligence on the part of the driver/respondent No.1 who
was driving recklessly on the road. If the driver/respondent
No.1 would not have done so, the said accident could have
been averted.

27-E.That the respondent No.1 being the driver cum

owner is liable to pay the compensation to the petitioners
being involved in rash and negligent driving.

27-F.That the respondent No.2 is also liable to pay the

compensation as claimed for being insurer of the offending
vehicle.

27-G. That the since deceased for whom the compensation is being
claimed, was a man of good physique and simple lifestyle when he
suffered fatal injuries due to rash and negligent driving of the
respondent No.1 and the since deceased was aged about 21 years
only and was working as Care Taker cum Supervisor at construction
site of Martand Infrastructure, and Agriculture driver and by
virtue that work, the deceased was getting salary of Rs. 30,000/- per
month along with food allowance. Since deceased was the elder son of
his family and all the petitioners No.1 to 03 i.e., the aged father ,
mother, younger brother were totally dependent upon the earning of
the since deceased and due to said accident he expired untimely due
to which the petitioners have lost the present, past and future income
of since deceased, the petitioners have also suffered immense mental
pain, loss of love and affection, agony due to the death of the since
deceased. The petitioners suffered monetary loss both in the present
and future, the petitioners further spent considerable money on
conveyance, funeral, cremation of the since deceased . The petitioners
are also entitled for compensation towards loss of natural love and
affection.

27-H.That the petitioners claims compensation to the tune of

Rs.70,00,000/- [Seventy lakhs rupees only] along with interest
@ 18% per annum from the respondents No.1 and 2 i.e. the
driver/owner and insurer of the offending vehicle respectively
jointly and severally on account of injury for mental pain,
agony, monetary loss, loss of enjoyment of life, loss of funds
upon death special and general damages and conveyance etc.
The petitioners a r e also entitled to compensate from the
consortium.

PART – II
28. Amount of compensation Rs.5,00,000/- (Rupees f i v e
claimed as interim award. lakhs only) as interim
compensation.
29. Reasons for claim of On the basis of no fault and
interim award. also due to the death

Note: That no such similar claim petition is filed or pending in any other
court between the same parties arising out of the accident.

PRAYER

It is therefore, respectfully prayed that this Hon'ble Court may graciously be

pleased to :

1. Pass an award for a sum of Rs.70,00,000/- (Rupees Seventy Lakhs

only) along with interest @ 18% per annum from the date of filing
the present petition till realization of the total awarded amount, in
favour of the petitioners and against the respondents jointly and
severally in the interest of justice;
 2. Pass an order for litigation expenses of Rs. 75,000/- (Rupees
Seventy-Five thousand only);

3. Any other relief which this Hon’ble Tribunal deems fit and proper
may kindly also be granted in favour of the petitioners.

GURUGRAM

DATED:

PETITIONERS

Rajesh, Mukesh, Balram

Through Counsel
Adv Gunjan Bhardwaj & Associates
 IN THE COURT OF MOTOR ACCIDENT CLAIM
TRIBUNAL, GURUGRAM, HARYANA
M.A.C.T. No. of 2024

IN THE MATTER OF:-

Sh. Rajesh & Ors. V/s Sh. Ramdev & Ors.

APPLICATION UNDER SECTION 166 & 140 OF THE

MOTOR VEHICLE ACT 1988 FOR GRANT OF
COMPENSATION
AFFIDAVIT
I, R a j e s h aged 44 years, S / o - Puriya, R/o-
Chudla,Mundawar, Hatoondi, Alwar, Rajasthan -
3 0 1 4 2 7 , do hereby solemnly affirm and declare as
under:-
1. That the deponent is the petitioner and is well conversant
with the facts of the case and competent to swear this
affidavit.
2. That the accompanying application/petition for claim
U/s.166 & 140 of M.V. Act, 1988 have been drafted by
my counsel under my instructions and the contents of
the same have been read over and explained to me in
my vernacular language.
3. That the deponent or any of the petitioners have not
filed any other similar petition with same cause of action
in any other court in India having jurisdiction to try this
petition except the present one.
4. That the Deponent had never been involved in any earlier
road accident and no tribunal had ever granted/ made
liable, for any compensation arising out of any motor
vehicle accident.
5. That no part of this affidavit is false and no materials facts
have been concealed therefrom.

DEPONENT
VERIFICATION

I, the above named Deponent, do hereby verify that the

contents of the Present affidavit are true and correct to the
best of my knowledge and belief, and no part of it is false and
no material facts have been concealed therefrom.

Verified at on this day of 20

DEPONENT