Page 758 - The Central Motor Vehicles Rules, 1989

730 THE CENTRAL MOTOR VEHICLES RULES, 1989 ANNEXURE-XIII

FORM-XV
SUMMARY OF COMPUTATION OF AWARD AMOUNT IN DEATH CASES
TO BE INCORPORATED IN THE AWARD
1. Date of accident ...............................................................................................................
2. Name of the deceased .....................................................................................................
3. Age of the deceased .........................................................................................................
4. Occupation of the deceased ............................................................................................
5. Income of the deceased ...................................................................................................
6. Name, age and relationship of legal representatives of deceased:

S. No. Name Age Relation
i.
ii.
iii.
iv.
v.

vi.
Computation of Compensation
S. No. Heads Awarded by the
Claims Tribunal
7. Income of the deceased (A)

8. Add-Future Prospects (B)
9. Less-Personal expenses of the deceased (C)
10. Monthly loss of dependency
[(A+B) – C = D]

11. Annual loss of dependency (D x 12)
12. Multiplier (E)
13. Total loss of dependency (D x 12 x E = F)
14. Medical Expenses (G)
15. Compensation for loss of consortium (H)
16. Compensation for loss of love and affection (I)

17. Compensation for loss of estate (J)
18. Compensation towards funeral expenses (K)
19. TOTAL COMPENSATION
(F + G + H + I + J + K = L)
20. RATE OF INTEREST AWARDED

21. Interest amount up to the date of award (M)