FORMAT OF APPLICATION FOR
COMPENSATION IN MOTOR ACCIDENT
In the Court of the Motor Accident Claims Tribunal ….(Name of
Place)
Claim Petition No. _______
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_________________________________ … Petitioner
VERSUS
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_________________________________ … Respondent
Application under the Section 166 & 140 of the
Motor Vehicle Act 1988 for grant of Compensation
1. Name & Father’s Name of the person
injured/dead (Husband’s Name in case
of married women & widow) :
2.
Full address of the person injured/dead :
3.
Age of the person injured/dead. :
4.
Occupation of the person injured/dead :
5.
Name & address of the employer of
