UNITED INDIA INSURANCE CO. LTD.

DIVISIONAL OFFICE, SHAHJAHANPUR

CHECKLIST-CUM-CLAIM NOTE
Ref. No. 2504003112C050027001/1 Dated : 10/11/14

Claim No. 2504003112C050027001/1 D.O. File SRE/DO/339/12

No.
MACT No. 06-13 Title Aabid V/S Ravinder Singh
Place of SAHARANPUR Our Anand Kumar Gupta
Court Advocate

PARTICULARS OF DECEASED/ INJURED:

AS PER PETITION
Name Aayesha Disability DEATH
Age 58 Yrs Multiplier
Income 4000/- Dependency 3
Occupati Sewing and household work Medical Exps.
on

DETAIL OF DEPENDENTS :

Sl. No. Name Age Relationship

1 Aabid 28 Yrs Son
2 Zakir 26 Yrs Son
3 Farhana 24 Yrs Daughter

DRIVING LICENCE : DOCUMENTS AVAILABLE ON FILE :

Name of Driver Rajib Investigation Report Yes

D.L. No. R-31110/SRE/2006 F.I.R. Yes
Issued By Saharanpur P.M. Report NO
Validity 29/11/2006 To 24/01/2013 Injury Report N.A
Valid For M-cycle/LMV(NT)/TV(H) Charge Sheet/Final Report Yes
Verified by SACHIN MEHTA Petition Yes
Whether NO Written Statement Yes
C.Sheeted

DETAILS OF INSURANCE POLICY

Policy No. 2504003111P133358972 64 VB Confirmation Yes

Issuing Office DO SRE Vehicle No./Type UP-11-E-4649
Period of Ins. 07/12/11 To 06/12/12 Make Van
Insured’s Arya Samaj Chapredi Regd. As Ambulance
Name
Date of 06/11/12 O/D Claim
Accident
Agency Direct

CLOSE PROXIMITY CLEARANCE : N/A

QUANTUM :

 Amount Claimed Rs. 1650000/-

  Provision as on Rs. 200000/-
31.03.14
 Amount Awarded Rs. 62200(40% of Rs.155500)/-
 Accrued Interest @ Rs. 8076/-
7%
1
INTERIM AWARD/AMOUNT DEPOSITED :

 Interim Award u/s 140 Nil

 Appeal Amount u/s NO
173
 Interim Payments 0
 Accrued Interest Nil

ADVOCATE’S OPINION :
Our defending advocate Sri A.K Gupta , has opined that Hon'ble court has awarded 40% of Rs.155500
which equals Rs.62200 +7% interest from date of petition 10-01-2013 which equals Rs. 4354.Total amount
hence equals Rs.70276(Seventy thousand two hundred and seventy six only.)

GROUNDS OF APPEAL : N.A

CITATIONS : Not mentioned by the advocate

PERMISSION U/S 170 OF M.V. ACT : N.A

DETAILS OF CONNECTED CASES : MACT Case no.:-07/2013

Title:-Rashda V/S Ravinder Singh

D.O. RECOMMENDATIONS :

Agreeing to our defending advocate, we are of the opinion that award may be satisfied for Rs.
70276(Seventy thousand two hundred and seventy six only.)

Admn. Officer. ASTT.MANAGER Sr.DIVISIONAL MANAGER