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TRIBUNAL, MUVATTUPUZHA
Petitioner
Vs
Respondents
1.
2.
3.
4.
5.
6.
I, * having been injured in a motor vehicle accident do hereby apply for the grant
of compensation for the injuries sustained.
Necessary particulars in respect of the injury, the vehicle etc. are given below.
PART I
Rs. Ps.
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
28. Any other information that may be necessary or helpful in the disposal of the
claim.
I, Solemnly declare that the particulars given above are true and correct to the
best of my knowledge and belief.
Petitioner
Vs
Respondents
Valuation Rs.
Court fee Rs.
Advocate