Page 756 - The Central Motor Vehicles Rules, 1989

728 THE CENTRAL MOTOR VEHICLES RULES, 1989 ANNEXURE-XIII

7. Computation of Compensation
S. No. Heads Claim of Response of
Petitioner(s) Respondent(s)
i. Income of the deceased (A)
ii. Add-Future Prospects (B)
iii. Less-Personal expenses of the deceased (C)
iv. Monthly loss of dependency
[(A+B) – C = D]
v. Annual loss of dependency (D x 12)
vi. Multiplier (E)
vii. Total loss of dependency (D x 12 x E = F)
viii. Medical Expenses (G)
ix. Compensation for loss of consortium (H)

x. Compensation for love and affection (I)
xi. Compensation for loss of estate (J)
xii. Compensation towards funeral expenses (K)
TOTAL COMPENSATION (F + G + H + I + J + K = L)
INTEREST

FORM-XIV
BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL
........................................... Petitioner(s)
Versus
........................................ Respondent(s)
FORMAT OF WRITTEN SUBMISSIONS TO BE FILED BY THE PARTIES
IN INJURY CASES
1. Date of accident .............................................................................................................
2. Name of the injured ......................................................................................................
3. Age of the injured .........................................................................................................
4. Occupation of the injured ............................................................................................
5. Income of the injured ...................................................................................................
6. Nature of injury ............................................................................................................
7. Medical treatment taken by the injured ...................................................................
8. Period of hospitalisation .............................................................................................
9. Whether any permanent disability? If yes, give details .........................................
..........................................................................................................................................
..........................................................................................................................................
10. Photographs of the injured and the injuries ............................................................