Affidavit of Claim before Motor Accident Claim Tribunal

BEFORE THE LD MEMBER, MOTOR ACCIDENT CLAIMS TRIBUNAL

M.A.C.P. No. /200 Filed on __________.

________________________________ Claimant.(s)

..Vs..
________________________________ Opponent (s).

A F F I D A V I T.

I, Claimant ________________________________ age _________
R/o ________________________________ Tq. __________ Distt. ________

Make oath and state on solemn affirmation as under :

1..
This claimant / deponent herewith filed an application under section 140 of M.V. Act,
1988 for grant of interim compensation. The contents in paras 1 to of that application are true to
my own knowledge. If my application will not be allowed, the claimant(s) will be put to an
irreparable loss and hardships. This is true on oath.

Dated :
_____________________________

V E R I F I C A T I O N.

The deponent named above solemnly affirms that the contents in para 1 above are true
to my own knowledge. Hence, signed and verified at on ____________________.

I know the deponent ________________________________ I have explained him
above contents to him in Marathi, who admits it then he has signed on this affidavit before me.

Sd

Identified by

ADVOCATE