Page 721 - The Central Motor Vehicles Rules, 1989

ANNEXURE-XIII THE CENTRAL MOTOR VEHICLE RULES, 1989 693

In Injury Cases:
1. Multi angle photographs of the injured
2. Proof of age of the injured which may be in form of (a) Birth Certificate; (b) School
Certificate; (c) Certificate from Gram Panchayat (in case of illiterate); (d) Aadhaar
Card, etc.
3. Proof of Occupation and Income of the injured which may be in form of (a) Pay
slip/salary certificate (salaried employee) (b) Bank statements of the last six
months (c) Income-tax Returns for the last three years (d) Balance Sheet, etc.
4. Treatment record, medical bills and other expenditure. In case of continuing
treatment give proof of future medical expenditure.
5. Proof of absence from work where loss of income on account of injury is being
claimed, which may be in the form of (a) Certificate from the employer; (b) Extracts
from the attendance register.
6. In case of legal heirs below the age of 18, copy of school ID, proof of school fee,
proof of other expenses/expenditure of the children
7. Bank Account no. of the injured near the place of his residence with name and
address of the bank along with the necessary endorsement
8. Proof of reimbursement of medical expenses by employer or under a Mediclaim
policy, if taken
9. Any other document
Other documents to be submitted
1. X Ray
2. CT Scan
3. ECG
4. Other documents
Verification:
Verified at ............................. on this ............................. day of ............................. that
the contents of the above Form are true to my knowledge and the documents attached
are true copies of the originals.
Name and signature of the injured/legal representative of deceased

S. No. Name Signature Photograph
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