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SEP
.v.. The Court of District Judge Patna,2 . . 72 ;
CI
›, ti Cum Motor Accident Tribunal
c ..1- 5.01, claim case no:37)) 2021 i
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In the matter of an Application
u/s-166 of Motor Vehicle Act 1988
read with Rule 228 of Bihar M.V Ru1es1988
1.Reena Devi aged about-26 years w/o-It-Sanjay Paswan @
Sanjay Kumar
2.Savitri Devi aged about-60 years w/o- It-Jaykishun Paswan

3.Sonam Kumar' aged about-8 years w/o-It-Sanjay Paswan @

Sanjay Kumar
Add-Muhalla-GangaNagar Kurji Balupar Sadaquat Ashram
PS-Digha Distt-Patna
VERSUS
1.Kundan Kumar s/o- Nagendra Ray
Addt-7A11-Pcito Ti-C6-11-(-
)adTerigha Ghat P.S- Digha Distt-Patna
Owner of offending Tempu no-BRO1PL-6619
2. Bajaj Allianz General Insurance Company Limited
5TH
Add-Alankar Place Floor, Boring Road Crossing Patna
Insurer of offending Tempu no-BRO1PL-6619
The Applicant do here by as legal representation for grant
of the Compensation account of Death of Sanjay Paswan
@Sanjay Kumar s/o-It-Jay Kishun Paswan who Died in a
Motor Vehicle Accident.

Necessary Particulars in respect of the Deceased, Vehicle etc

are Given Below.

1-Name and Father Name of erson Dead:-Sanjay Paswan

sic) -c1-1- K iSMtn Rai.32n,
 1Has any Claim been lodged against Owner ?:-Not Filed by
so with what result. Any claim and any other court.

3.Full Address of the Person Dead;-At- Muhalla-GangaNagar

Kurji Baluper ,Sadaqat Ashram

PS-Digha Distt- Patna

4.Age of the Person Dead;-35Years

5.0ccupation of the Person Dead:-Vegetable Seller

6.Name and Address of the Employer 4 Dead, if any:-NA

7.Monthly Income of the Person Dead;-15000/-per month

8.Does the Person in respect of whom compensation is :-NO

Claimed Income Tax.

9.Place date and Time of Accident:-The Accident happened

infront of Van sati Mandir on

road PS-Digha Distt-Patna on

dt-4-7-2021 at about-10:30PM

10.Name and Address of the Police Station:-The Accident took

Under the Jurisdiction of

Traffic Gandhi Maidan and the

 Case was.regitereci as Traffic

Gandhi Maidan case no-82/2021

dt-5-7-2021.

11.Was The Person in respect of whom Compensation is:- NO

Claimed travelling by the Vehicle involved in the Accident?

if so give the name of Place of starting of Journey.

12.Nature of Injury sustained and continuing effect-Death

if any the Injury.case case

11Name and Address of Medical officer who attened;-NA

on Dead.

14.Period of Treatment and Expenditure if any: NO

incurred thereon.

15.Registration number and type of Vehicle involved:-Tempu

In the Accident. No- BRO1PL-6619

16.Name and Address of Owner of the Vehicle:-Mentioned

On the Title Page

17.Name and Address of the Insurer of the Vehicle;-Mentio-

ned on the Title Page

 18.Name and Address of the Applicants;-Mentioned on the

Title Page

19.Relationship of the Deceased:-Claimant no-1 is wife 2 is

mother & 3 is minor son of the Deceased

20.Title of the Property of the Deceased:-X

21.Amount of the compensation claimed;-15,00000/(Fifteen

Lakhs)only with loss of state and Funeral expences an
Future Prospect and claimant are also entitled to interest
thereon 12 percent per annum from the filing of this case till
its realization.

22.Brief Particulars of the Accident:-

1.That the facts of the case is that on dt-4-7-2021 Deceased

Sanjay Paswan Sanjay Kumar was coming his home from

Rupaspur by a Tempu bearing no-

BROIPL-6619.when the

said Tempu reached infront of Van sati Mandir, at the

mean time the said tempu collided with A Truck, due to

rash and negligent driving of driver of ten-

ipu bearing no-

BRO1PL-6619,at resulting Sanjay Paswan @ Sanjay Kumar

get grievously injured and died on the spot.

2.That Sanjay Paswan (Sanjay Kumar was a vegetable

seller and for this heeanaer

•• E• mo_rjah • --.„-
f•

3.That thereafter Deceased Postmortem commenced in

PMCH Patna and on the basis of a Ferdbeyan of Raju Paswan
A case is registered as Traffic Gandhi Maidan P.S case No-
82/21 dt-5-7-21 u s- 304(A) of1PC was registered
against the said Tempu driver and owner of Vehicle and case
was under investigation.

4.That the aforesaid Tempu bearing reg no-13R01PL-6619

was being driven very rashly and negligently by its driver.

5.That Particulars given are sufficient to adjudicate the case

in hand however it is relevant to justify here that the

Deceased Sanjay Paswan @ S,anjay Kumar have much expectation

from himself.

6.That his Family have suffered irreparable loss after death of

Sanjay Paswan @ Sanjay. Kumar.

7.That his family have suffered irreparable loss after death of

Sanjay Paswan @ Sanjay Kumar. hence they are suffering from

a huge pecuntry loss alongwith loss of love and affection, mental
pain agony.They are now forced to spend a miserable orphan life
Their Future prospects has been now block.
 It is therefore prayed that your Honour may be
pleased to admit this Claim petition and direct
the opposite party who ever liable to pay Rs
j 0 0 0 OD
:I-as Compensation to the
Claimants alongwith appropriate interest from

the date of filing of the case.

And for this Claimants shall ever pray.

it; 5r( f4
(
savil-n__92s/

VERIFICATION

1 r e.as-nq „ll t
aged about
VI11-1<whincilulecet%407S- g\Ack years w/o 20coickt3 (Pcm_cct
Aglaac_cin DISTT-Raier\ el\ do here by
verify that particulars given above are true and correct to the best of
my Knowledge.

Verified and signed /Put L.T.I. on this petition

on ..................... in the premises of Civil Court PATNA.

fl(2-7:\O
 LYPICT I /: '466211710

Nil .01HAB Col '0

MCI 71E0 060
17-JUL

.
1/11111111111 111E1

I rikeeilck bey; aged about years ce-1-ttLoqcy-A

R/O-Village4k41544051_,PS- St‘c\ Distt-ckk-nq
°pampa+ Atrta
do here by solemnly affirm and declare as Follows:-

(1) That I am Claimant no- -tin the aforesaid case and I

am fully acquainted with the entire facts and circumst-

ances of the case.

(2).That the entire contents of the Petition as well as

This affidavit have been read by me and understood

by me and the same are true and correct to the best

of my knowledge and belief.

Verified and signed on this day of

,2021 at civil court Patna.

Deponent

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