IN THE SESSIONS COURT AT AYER KEROH

IN THE STATE OF MELAKA

CIVIL SUIT NO.: 53-XXXX-2018

BETWEEN

1. U SAPA
(NRIC NO.: xxxxxx-xx-xxxx)

2. MIE MANGKOK
(NRIC NO.: xxxxxx-xx-xxxx) …PLAINTIFFS

AND

1. WIE SAMA
(NRIC NO.: xxxxxx-xx-xxxx)

2. HAI YUN TRAVEL SDN. BHD.

(COMPANY NO.: X-xxxxxxxxx) …DEFENDANTS

STATEMENT OF CLAIM

1. The First Plaintiff is the rider of motorcycle no. MCA 5906 at all material date and time with

the residential address at ……………. .

2. The Second Plaintiff is the pillion rider of motorcycle no. MCA 5906 at all material date and

time with the residential address at…………. .

3. The First Defendant is the driver of motorbus no. MBJ 1978 at all material date and time with

the residential address at ……………. .

4. The Second Defendant is the owner of motorbus no. MBJ 1978 at the material date and time

bearing the business and service address at …………… .

5. On 19.05.2016 at or about 9.30 pm, the First Plaintiff was riding motorcycle bearing

registration number MCA5906 with the Second Plaintiff along Jalan Ayer Keroh from Plaza

Toll Ayer Keroh, heading towards the Melaka city.

6. As the Plaintiffs were about to pass one PETRONAS Petrol Station that was situated on the

left side of the road, a bus driven by the First Defendant bearing registration number MBJ1978

[hereinafter referred as ‘the said bus’] approaching from the opposite side of the road had

suddenly made a right turn encroaching into the rightful path of the Plaintiffs.

7. Although the First Plaintiff tried to swerve to the right, he was still unable to avoid a collision

with the said bus, which had caused the motorcycle to be knocked into the left side of the said

bus [hereinafter referred as ‘the accident’].

8. The accident was caused by the negligence and/or contributory negligence of the First

Defendant.

9. The Second Defendant is wholly/partially liable as the owner of motorbus no. MBJ1978 for

allowing the First Defendant to drive the said bus.

PARTICULARS OF NEGLIGENCE OF THE FIRST DEFENDANT

a) Colliding into the path of motorcycle no. MCA5906.

b) Failure to pay due attention and care to the presence of the plaintiffs.

c) Failure to consider the safety of other road users and in this case, the plaintiffs were

affected.

d) Violated the plaintiff’s traffic rights.

e) Failure to allow the plaintiffs to pass safely before turning right.

 f) Failure to stop, reduce speed and/or take any other measures to prevent the said accident.

g) Failure to observe or to pay attention to the traffic rules and regulations.

h) Failure to maintain a safe distance from the first plaintiff’s motorcycle.

i) Failure to give way to the plaintiff’s vehicle.

j) Knowing a dangerous situation is being built but still failed to take any necessary action to

avoid the said accident.

k) Driving in a careless manner.

10. By reasons of the matters aforesaid, the Plaintiffs sustained severe injuries and has suffered

losses and damages respectively.

PARTICULARS OF PLAINTIFF’S INJURIES

A. First Plaintiff

a) Compound grade III B supracondylar fracture of left femur with extension into knee

joint;

b) Closed fracture mid-shaft left radius;

c) Closed fracture of left fourth metacarpal;

d) Scarring

e) Permanent disabilities as a result of serious injury to the left leg

(A copy of the First Plaintiff’s medical report will be presented during trial)

B. Second Plaintiff
 a) Closed fracture of left femur

b) Permanent disabilities suffered as a result of the fracture to the left femur

c) Cerebral concussion;

d) Scarring:

(A copy of the Second Plaintiff’s medical report will be presented during trial)

PARTICULARS OF PLAINTIFFS’ SPECIAL DAMAGES

A. First Plaintiff

a) Loss of Earning as a mechanic of RM1,200 per month RM 21,6000.00

for 18 months

(RM1,200.00 x 18)

b) Police report RM 8.00

c) JPJ Search RM 10.00

d) Damage to clothes, shoes and helmet RM 200.00

e) Transportation expenses for the purpose of visitation RM 100.00

by family members

(RM25.00 per trip x 4)

f) Medical bills from Hospital Melaka RM 7,125.00

g) Cost of repair of the said motorcycle RM 720.00

TOTAL RM 29,763.00
B. Second Plaintiff

a) Loss of Earning of RM900 per month for 1 year RM 10,800.00

(RM900.00 x 12)

b) Damage to clothes, shoes and helmet RM 200.00

c) Transportation expenses for the purpose of visitation by RM 100.00

family members

(RM25.00 per trip x 4)

d) Medical bills from Hospital Melaka RM 6,956.00

TOTAL RM 18,056.00

The First Plaintiff Plaintiffs prays for;

a) General damages

b) Special damages which amounts to RM29, 763.00.

c) Interest;

d) Cost; and

e) Other relief as the Honourable Court may deem fit.

And, the Second Plaintiff Plaintiffs prays for;

a) General damages

b) Special damages which amounts to RM18, 056.00.

c) Interest;

d) Cost; and
 e) Other relief as the Honourable Court may deem fit.

Dated this __ day of _______ 2018

………………………….

Solicitors for the Plaintiff

This Statement of Claim is filed by MESSRS. MOZHI, CHARUMATHY & ASSOCIATES,

Solicitors for the Plaintiffs whose address for service is at No.11, Jalan Bahagia, Taman Harmoni,
75400 Melaka.

(Ref No.: CN/KS/UCV/17/2018/KCA)