Page 746 - The Central Motor Vehicles Rules, 1989

718 THE CENTRAL MOTOR VEHICLES RULES, 1989 ANNEXURE-XIII

Compensation of loss for love and affection (I)
Compensation for loss of estate (J)

Compensation towards funeral expenses (K)
Total Compensation
(F+ G + H + I+J+K = L)
INJURY CASE
22. Name of the victim

23. Age of the victim
24. Occupation
25. Monthly Income
26. Nature of Injury
Simple
Grievous
27. Type of Injury

28. Details of medical treatment
29. Details of permanent disability (if any)
30. Computation of compensation Amount in Rs.
Expenditure on treatment
Expenditure on conveyance
Expenditure on special diet

Cost of nursing/attendant
Cost of artificial limb
Loss of earning capacity
Loss of income
Any other loss which may require any special
treatment or aid to the injured for the rest of
his life
Compensation for mental and physical shock
Pain and suffering

Loss of amenities of life
Disfiguration
Loss of marriage prospects