- am the eourt of District Judge cum M.A claim Tribunal katihak, | Ghat. katinar, : So “Rok. MeVeclaim no~ 28/2929 Reeta Chakraborty w/o late kivonmay chakraborty age obout $4 years restent a€ village Durgasthan colony no, 2,kotahar, pa hotiher, Gistteketibars , => claimants - Lye tia 2 Bee oe sey aks = _zenkaj kama arya o/o Wend Pragad Abya aged about weeeyoaks residént of village Seurtyay pa, soGriya,ps pandkhora, ditt, katihar, owner of the tractor bearing regiotrotion foeBR 39. Gh S07. nhoes aan’ ne i Cm one 2, AMAL Ritar Mand&l=e/o-coren-Mandal aged. ebout 24 years, resident of village Soralya, Pele- “ 2) -angxhora,Gistt.katihar driver of vehicle tractor LOGI eNDRYGA,5079 and trailer bearing registration nos BR 39 GA 5225 3eThe Divisional Managers Bajaj Allianz Ceneral Insurance company Limited, 3 Plaza,Airport Read Yerwada rune 4112006 “-dnsueer of the vehfele tractor bearing rogd.no,. * Basan 6079 » 4,fhe Dranch Manager ,United India Insurance company ztd,Canara Bank Building ciris High school road, Alen Market katihar,ps Nagar, distt.Mathar,Gihar pin @ 654105 insurer of the vohictebearing reqtetration 119-BR39 GA 5225. u/s 166 Mv Act. . . ae ee hucbie application £iled on behalf -£ the claimant, most respectfully shaweth , Riu Reeta chakraborty w/o late Kiranmay chakroborry resident of village Durgasthan colony no,2,ps @ nagar, distt.katihor hereby apply for the grant of compensation omount of death of Xirammay chakreborty s/o late Maninéra peer chandra aks xaaiiex chakeabeety, aga about 67 yoors - who died in motor accidents 'ae novessary particulars of the deceased Kirennay eshakralpets chakraborty s/o Late Manindra chandra chakraborty and the vohicle ote, given below Jetione and father*e none of <«Kiranney chakraborty the deceased~ 8/o Lote Maninéra chancra chekroborty. 2e Full addrese of person - village sphalla Durgasthen doade colony noe2,ps nogar, diett, katihar, 3s ayo of the peroon cende—= about G7 years, : 4. occupation of the person ~ dead i Dermrater ond Tent house. I “be name of the employer of deceased= = th : Getpnthly income of the runeea~ - -Ree29,099/— (twenty thousand}on1. Geceased~ 1 ¥ J= Does the peraon in respect l of thom £6 claimed pay > inasme tax . - > | 'ae 3 * AF Brert0d of treatnent end expenditure ££ any ancurred thereon. Spot death, 24. Rogistration Rorber ang “type of vohtere involved tn accident, tractor regd.no BR, 390A.5225, : : 45. Name ang adaresa of the owner “Pankaj kumar Arya (owncr) « Of the vehicle & driver ; he 8 /@ Mand Prasad Arya, of vehicle,’ R/ village *ourtya, PO, Souriya,sps Dandxnora, distt.kattnar (Bihar) 2) Praver andi tumer Mandal s/o Soren Mandal ab Fendden’ of village Sartya, . pS Dendkhora, distt. katihar and address of snsurere(1) the aiviedonat Nenager, ~~ Bajaj Alldane Genera Insurance company Limited GE Plaza, Airport Road, Yerwada pune 411006 insurer o¢ the vehicle tractor bearing Teg .BR ZB. GA 5079 Pobity Me -06-19~240Y- 9/7 -20000418 2)Tho Branch Manager United India Insurance Company Ltd,Canara Bank building Ciris Haigh school, ee - Rood, Alam viarkot,Katdhar,ps ree 7 Reger diott ratihar, RyM-- A239 GA Sa2y, Pohicy Ne - 21030231) 8 p NO581C04ww? ij= Has any claim lodged against the owner /ingurere- De i@eNone ond odéreesa of claimont== Resta chakraborty . -.W/o Late xirenmay — chakraborty. 49, Relationship of claimant eLaimant is the wife With deceasad~————= of the deceased, 29, Title to the Pmperty- Being legal heir has got Se x full title to the property Low ob - o£ the deceasad,, 21- atount of compensation of cletmor (a) Pecuntary lose(Maltiplier 5) RE~12,09,930/~ (laos 1/3rd amount deducted ) () Rey 4,02,999/7 ene Re dy 99,092/— (b) cost of carrying dead body- _ RBs 15,000/ fe) cout of love Gaffection of : . “a7 RBs 49,0997 eTaimant = ‘a mental shobk o£ claimant 215,099, ~ total- RBe 4, 713,090/—8) 28. Any other information that may be necessary or halpful in dieposal of the claing~ . That the cause of action for the claim arsec on 15,20.2019 when tho accident took place due to reach end jR@gligent driving of tho driver of the vehicle erockst® bearing regd.no.0R 39 GA 50%. That the deceased was very healthy atie wae maintaining his entixe family members in very voll manner and he ° had good idea for the progress and uviiftment of the os ib family. > Thot no award or amount of money can compensate the actual loss but for the sake of compensation anount noted in eoluan 22 £2 claimed money avarded the claimants againet the Opes that ony other future relief thet may be decearcd expendent in the gnterest of justice bs alas awarced to the claimant ajainet the opay ~verification with affidavit. a i,Raeta chakgaborty w/o late Kizanmay chakraborty geeident of villago/mhaila Dusgasthan, colony ho, 2, ps : é bette cee kotshon,distt.katihar, é hereby jeolemnly affirm and declare that the contents of this pleint (iv claimp are true to thebest of ay knowledge, belief ané informe, tions verified ang sighed today the---dayof January, Sey 20229 within the courte compound, katahar, “@ ws Heontbesedby advocate