BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL AT TIRUVALLUR

[Link]. of 2024

1] [Link] age 63
F/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,Abirami Madam,
Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
2] Gowri age 53
M/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
3] Minor Pattu age 12
Represent by her Gurdian father Munusamy
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203
…. Claimants /Petitioner
-Vs-
1] [Link] S/o Ponnu Muthu,
No 4 Bajana Koil Street, Pulicat,
Ponneri , Thiruvallur- 601205
2] The Manager Reliance GIC LTD.
H Block 4th Street, Door No.12,
H 2035,15 th Main Raod
Annanagar West, Chennai-600101. ……Respondents
 PETITION UNDER SEC.166 OF [Link] & RULE 3 OF MACT RULES

WE ARE PETITIONERS: 1] [Link] age 63,F/o Deceased Ganjendran, No.30-31

Senjiyamman Nagar,Abirami Madam, Kadapakkam Village, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203. 2] Gowri age 53 M/o Deceased Ganjendran. No.30-31
Senjiyamman Nagar, Abirami Madam, Kadapakkam Village , Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203. 3] Minor Pattu age [Link] by her Gurdian father
[Link].30-31 Senjiyamman Nagar, Abirami Madam, Kadapakkam Village , Kattur
Post,Siru Payaverkadu, Ponneri Taluk ,Tiruvallur-601203 do hereby apply for the
compensation for the deceased of Mr. M. Gajendran in the road accident on 06.10.2023 at
about 12.00 hrs, at Minjur to Kattur Road Near Kattur Puttru Temple with in limit of
Redhills TIW.

The Address of Service:- R. RAJKUMAR [2323/2018] [Link] [1473/2018],M.

ANBARASAN [2835/2017]ADVOCATES No. 8/1 4 F ETPS Main Camp Ennore Camp-1
Chennai-57 Mob:9698809996

Necessary Particulars in respect of deceased, Vehicle given below:-

1 Name and Father's Name of the [Link].

Person injured S/o Munusamy

2 Full address of the Person No.31 Senjiyamman Koil street,

injured/Deceased Kadappakm Villege, Kattur Post,
Ponneri Taluk, Tiruvallur district -

3 Age of the Person injured/ 23

Deceased

4 Occupation of the Person Labour

injured/ Deceased

5 Name & Address of the Self employee

Employer of the injured/
Deceased
6 Monthly Income of the person Rs.30,000/-
injured/ Deceased

7 Does the person in respect of No

whom compensation is claimed
pay income tax? If so state the
amount of income tax

8 Place, date and time of accident On 06-10-2023 at 12:00 Hrs in Minjur

to Kattur Road Near Kattur Puttru
Temple with in limit of Redhills TIW

9 Name and address of the Police The Police station-Redhills TIW in

station in whose jurisdiction Avadi City TIW District- Registered the
accident took place or was Case under Crime No.627/2023 U/S 279
registered 304 A IPC.

10 Was the person in respect of On 06-10-2023 at 12:00 hrs Deceased

whom compensation is claimed rider of the Two wheeler TN 18 S 2290
traveling by the vehicle involved travelled Minjury Kattur Road toward
in the accident? If so give the North to South direction near Kattur
name and place of starting the Puttru temple at the time Accussed
journey and destination Vehicle TN 18 AR 8175 driver drove a
vehicle rash and negligent menner
dashed against deceased vehicle. result
of accident Deceased Gajendran died.,

11 Nature of Injuries sustained and Death

disablement, if any, caused

11, Details of the damges caused to Two wheeler and Clothes

a) the propertyon account of the
accident

12 Name and address of the Government Stanly Hospital- Chennai

Medical Officer/ Practitioner, if
 any who attended the injuries

13 Period of treatment and 06-10-2023 to 28-10-2023

expenditure if any incurred

13, Disability of work if any caused. Death

a)

14 Registration Number and type of TN 18 AR 8175 TATA ACE GOLD BS

vehicle involved in the Accident IV

15 Name and Address of the owner [Link] S/o Ponnu Muthu, No 4

of the vehicle Bajana Koil Street, Pulicat, Ponneri ,
Thiruvallur- 601205

16 Name and address of the insurer Reliance General Insurance Ltd.

of the vehicle H Block 4th Street, Door No.12, H
2035,15 th Main Raod Annanagar West,
Chennai-600101.
PolicyNo.120322323340067804. Policy
Period 17-08-2023 to 16-08-2024.

16,a) Name and address of Driver of [Link] S/o Anandhan, No.50 MAL
the Offending Vehicle Street Kulathumedu Pulicut Post,
Ponneri Taluk, Tiruvallur-601205

17 Has any claim been lodged with No

the owner, insure if so, by the
Applicant with what result

18 Name and Address of the 1] [Link] age 63 F/o Deceased

Applicant Ganjendran. No.30-31 Senjiyamman
Nagar Abirami Madam, Kadapakkam
Village, Kattur Post, Siru Payaverkadu,
Ponneri Taluk Tiruvallur-601203. 2]
Mrs. Gowri age 58 M/o Deceased
Ganjendran. No.30-31 Senjiyamman
 Nagar Abirami Madam, Kadapakkam
Village, Kattur Post, Siru Payaverkadu,
Ponneri Taluk Tiruvallur-601203. 3]
Minor Pattu age 12. Represent by her
Gurdian father [Link].30-31
Senjiyamman Nagar, Abirami Madam,
Kadapakkam Village , Kattur Post,Siru
Payaverkadu, Ponneri Taluk ,Tiruvallur-
601203

19 Nature of the Relationship with 1] [Link] age 63 Father of

diseased/ Injured Deceased Ganjendran. 2] Mrs. Gowri
age 53 Mother of Deceased
Gajendran.3] Pattu age 12 Sister of
Deceased Gajendran

20 Title of the Property of the Does not arise

deceased

21 Amount of Compensation Rs.60,00,000/- (Rupees Sixty Lakhs

claimed and basis thereof Only)

21-a. Particulars of loss and expenses.

PART-I

I. Loss of earning from to

II. Partial loss of earnings from

III. Medical expenses

IV. At the net rate Rs.

V. Transport to hospital

VI. Extra nourishment

 VII. Damage clothing and
articles

VIII. Other (motor cycle

damages)

PART II

a) Compensation for pain and

suffering

b) Compensation for continuing

of Permanent disability if any

c) Compensation for loss of 58,50,000

earning owner.

d) Loss of Consortium 40,000

e) Loss of Estate 15000

f) Funeral Expense 15000

f) Loss of Love and affection 80,000

TOTAL
Rs.60,00,000/- (Rupees Sixty Lakhs
Only)

22 whether application not made Made within time

within six month of the
occurrence of the accident the
cause thereof

22-a) i) Whether the injured/deceased -No-

had been Involved in any other
road accident earlier

ii) Whether the injured/deceased -No-

had preferred a claim for
 damaged in my case earlier

iii) Whether the injured/deceased -No-

is related to bor has known the
owner of the vehicle and if so
now?

23. Any other information that may be necessary or helpful in the disposal of the claim:-

The petitioner submits that the accident occurred when the deceased Gajendran was driving a
two-wheeler Reg No. TN 18 S 2290 Minjur to Kattur road in a north-to-south direction,
much observing traffic rules and regulations near Kattur Putturu Koil Temple on 06-10-
2023, at about 12:00 hrs. At the time, the first respondent driver drove the TATA ACE
bearing Registration No. TN 18 AR 8175 vehicle from the same direction in a rash and
negligent manner, without observing any traffic rules, and dashed behind the deceased two-
wheeler as a result of the accident. The deceased Gajendran sustained a head injury along
with multiple injuries. Immediately, he was taken to the GH Ponneri by ambulance. First aid
was done after the deceased condition was very serious, so the doctor referred him to Stanly
GH for further treatment. He was admitted there from 06-10, 2023, to 28-10, 2023, but
during the treatment, the deceased Gajendran died on 28-10-2023 at 08:30 hrs without
responding to the treatment. The accident happened only due to the rash and negligent
driving of the driver of the TATA ACE bearing Registration No. TN 18 AR 8175. Based on
that, Redhills TIW registered the complaint against the 1 st respondent vehicle, so the accident
occurred due to the sole negligence of only the 1st respondent vehicle driver.

At the time of the accident the deceased was aged about 23 years and he was well and
healthy. Due to the above mentioned grievous Injuries occurred he was died on 28.10.2023 at
in Stanly GH Hospital at Chennai.

After his demise, the entire family lost their day-to-day life because remembrance of their
son and they started starving without any income. They are unable to make both ends meet.
They have suffered loss of income as well as loss of love and affection. His life is tossed in
the air like a leaf.

The 1 and 2nd petitioners lost their Son and 3rd petitioner lost has brother in the accident.
Without any hope they are unable to running their life, to concentrate anything and to do any
work become sick and bedridden. Due to the sadness, the petitioners were unable to maintain
the family. They are leading poverty stricken life. They have no hand cash or savings on
bank at present. They haven't moveable or immoveable properties. They are unable to pay
the competent court fee on the main application at present.

Court fee Rs.20/- paid along with this main petition,

A court fee Rs.59,372.50 is payable under Rule 24(1) of MACT Rules.

A Separate application Rule 24(3) is filed herewith.

23-a) To state how the respondent are to liable to pay compensation to the

The 1" respondent being the cum Owner, the 2nd respondent being the insurer of TATA
ACE bearing Registration No: TN 18 AR 8175. all are jointly and severally liable to pay the
compensation to the petitioner. Hence it is therefore prayed that, this Hon'ble court may be
pleased to award for a sum of Rs. 60,00,000/- towards compensation with interest at 12% per
annum from the the date of filling this petition cost and advocate fees etc.,

Advocate For Petitioner Petitioners/ Claimants

Verification

We are the petitioners here in do hereby declare that the particulars given above are true and
correct to the best of my knowledge and belief and the same we are read over and explain to
me in tamil and that I have not claimed or obtained any compensation under the work men
compensation act 1923, so far as this case is and we signed in this at on
 Petitioners

List of Documents

S No Date Particulars

1 FIR

2 RC

3 Driving License

4 Policy

5 Motor vehicle inspection report

6 AR

7 Post mortem

8 Death certificate

9 Legal Heirs certificate

10 ID proofs of Claimants

11 ID proof of Deceased.
 BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL AT

Thiruvallur

[Link]. of 2024

1] [Link] age 63
F/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,Abirami Madam,
Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
2] Gowri age 53
M/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
3] Minor Pattu age 12
Represent by her Gurdian father Munusamy
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203
…. Claimants /Petitioner
-Vs-
1] [Link] S/o Ponnu Muthu,
No 4 Bajana Koil Street, Pulicat, Ponneri , Thiruvallur- 601205
2] The Manager- Reliance GIC LTD.
H Block 4th Street, Door No.12,
H 2035,15 th Main Raod
Annanagar West, Chennai-600101. ……Respondents

AFFIDAVIT OF Mr. MUNUSAMY

I, [Link] age 63,F/o Deceased Ganjendran, No.30-31 Senjiyamman Nagar,Abirami

Madam, Kadapakkam Village, Kattur Post,Siru Payaverkadu, Ponneri Taluk ,Tiruvallur-
601203, do hereby solemnly affirm and sincerely states as follows:

1] I am the deponent herein and the 1th petitioner in the above MCOP and as such I am
well aware of the facts of the case stated hereunder.

2] I submit that I am swearing this affidavit on behalf of me and behalf of the other
petitioners who are none else than my wife and Daughter respectively.

3] I submit that I have been applied for the compensation for the Death met with the road
accident On 06-10-2023 at 12:00 Hrs in Minjur to Kattur Road Near Kattur Puttru Temple
with in limit of Redhills TIW

4] I further submit that the accident occurred when the deceased Gajendran was driving a
two-wheeler Reg No. TN 18 S 2290 Minjur to Kattur road in a north-to-south direction,
much observing traffic rules and regulations near Kattur Putturu Koil Temple on 06-10-
2023, at about 12:00 hrs. At the time, the first respondent driver drove the TATA ACE
bearing Registration No. TN 18 AR 8175 vehicle from the same direction in a rash and
negligent manner, without observing any traffic rules, and dashed behind the deceased two-
wheeler as a result of the accident. The deceased Gajendran sustained a head injury along
with multiple injuries. Immediately, he was taken to the GH Ponneri by ambulance. First aid
was done after the deceased condition was very serious, so the doctor referred him to Stanly
GH for further treatment. He was admitted there from 06-10, 2023, to 28-10, 2023, but
during the treatment, the deceased Gajendran died on 28-10-2023 at 08:30 hrs without
responding to the treatment. The accident happened only due to the rash and negligent
driving of the driver of the TATA ACE bearing Registration No. TN 18 AR 8175. Based on
that, Redhills TIW registered the complaint against the 1 st respondent vehicle, so the accident
occurred due to the sole negligence of only the 1st respondent vehicle driver.
5] I further submit that the 1st respondent is the owner of the vehicle and the 1 st
respondent vehicle is insured by the 2nd respondent the Reliance General Insurance Ltd.

6] I further submit that my son is the only bread winner of my family and have no means.
The claim of the petitioner is just and reasonable one. The respondents are liable to make
good for the loss occasioned to us.

7] I further submit that we had not filed any claim petition before any court of law with
respect of this accident referred above.

8] I further state that I pay a sum of Rs.372.50 as court fee for Rs.60,00,000/- alone. I
further submit that the court fee payable on the main petition which comes to Rs. 59,000/- for
which separate petition filed for exemption.

9] I further submit that the petitioner has no means and the petitioner depends on of his
own income only. Hence, the petitioner couldn’t able to pay the court fee and the act is
neither willful nor wanton but only due to the reasons stated above. If the above petition is
not allowed I will be put to serious loss and hardship on the other hand no prejudice or
hardship would be caused to the respondents herein in allowing the application.

It is therefore prayed that this Hon’ble Court may be pleased to waive the above court
fee of Rs.59,000/-. to the claim of an award of Rs.60,00,000/- in favour of the petitioners as
against the respondents, together with interest @ 12% p.a. from the date of accident till the
date of realization and thus render justice.

Solemnly affirm at Tiruvallur ] Before Me

On this the day of ]
And signed his name in my presence ] Advocate Tiruvallur
 BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL AT

Thiruvallur

[Link]. of 2024

1] [Link] age 63
F/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,Abirami Madam,
Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
2] Gowri age 53
M/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
3] Minor Pattu age 12
Represent by her Gurdian father Munusamy
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203
…. Claimants /Petitioner
-Vs-
1] [Link] S/o Ponnu Muthu,
No 4 Bajana Koil Street, Pulicat, Ponneri , Thiruvallur- 601205
2] The Manager - Reliance GIC LTD
H Block 4th Street, Door No.12,
H 2035,15 th Main Raod
Annanagar West, Chennai-600101. ……Respondents

PETITION UNDER RULE 24 (3) OF T.N.M.V.C.T RULE 1989

For the reasons stated in the accompanying affidavit and in the interest of justice it is
very humbly prayed that this Hon’ble Court may be pleased to waive the above court fee of
Rs.59,000/- to the claim of an award of Rs.60,00,000/- in favour of the petitioner as against
the respondents, together with interest @ 12% p.a. from the date of accident till the date of
realization and pass further or other orders as this Hon’ble Court may deem fit and proper in
the above circumstances of the case thus render justice.

Dated at Chennai on this the day of 2024

Counsel for Petitioners/Claimants.

 BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL AT

Thiruvallur

[Link]. of 2024

1] [Link] age 63
F/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,Abirami Madam,
Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
2] Gowri age 53
M/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
3] Minor Pattu age 12
Represent by her Gurdian father Munusamy
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203
…. Claimants /Petitioner
-Vs-
1] [Link] S/o Ponnu Muthu,
No 4 Bajana Koil Street, Pulicat, Ponneri , Thiruvallur- 601205
2] The Manager - Reliance GIC LTD
H Block 4th Street, Door No.12,
H 2035,15 th Main Raod
Annanagar West, Chennai-600101. ……Respondents

UNDERTAKING AFFIDAVIT [Link]

I, [Link] age 63,F/o Deceased Ganjendran, No.30-31 Senjiyamman

Nagar,Abirami Madam, Kadapakkam Village, Kattur Post,Siru Payaverkadu, Ponneri
Taluk ,Tiruvallur-601203, do hereby solemnly affirm and sincerely states as follows:

1] I am the deponent herein and the 1th petitioner in the above MCOP and as such I am
well aware of the facts of the case stated hereunder.

2] I submit that I am swearing this affidavit on behalf of me and behalf of the other
petitioners who are none else than my wife and Daughter respectively.

3] I submit that I have been applied for the compensation for the Death met with the road
accident On 06-10-2023 at 12:00 Hrs in Minjur to Kattur Road Near Kattur Puttru Temple
with in limit of Redhills TIW

4] I further submit that the accident occurred when the deceased Gajendran was driving a
two-wheeler Reg No. TN 18 S 2290 Minjur to Kattur road in a north-to-south direction,
much observing traffic rules and regulations near Kattur Putturu Koil Temple on 06-10-
2023, at about 12:00 hrs. At the time, the first respondent driver drove the TATA ACE
bearing Registration No. TN 18 AR 8175 vehicle from the same direction in a rash and
negligent manner, without observing any traffic rules, and dashed behind the deceased two-
wheeler as a result of the accident. The deceased Gajendran sustained a head injury along
with multiple injuries. Immediately, he was taken to the GH Ponneri by ambulance. First aid
was done after the deceased condition was very serious, so the doctor referred him to Stanly
GH for further treatment. He was admitted there from 06-10, 2023, to 28-10, 2023, but
during the treatment, the deceased Gajendran died on 28-10-2023 at 08:30 hrs without
responding to the treatment. The accident happened only due to the rash and negligent
driving of the driver of the TATA ACE bearing Registration No. TN 18 AR 8175. Based on
that, Redhills TIW registered the complaint against the 1 st respondent vehicle, so the accident
occurred due to the sole negligence of only the 1st respondent vehicle driver.

5] I further submit that the 1st respondent is the owner of the vehicle and the 1 st
respondent vehicle is insured by the 2nd respondent the Reliance General Insurance Ltd.

6] I further submit that my son is the only bread winner of my family and have no means.
The claim of the petitioner is just and reasonable one. The respondents are liable to make
good for the loss occasioned to us.

7] I further submit that we had not filed any claim petition before any court of law with
respect of this accident referred above.

8] I further submit that there is no similar petition neither filed nor pending for before any
court of law for claiming compensation with respect of this accident referred above.

It is therefore prayed that this Hon’ble Court may be pleased to record this affidavit
and thus render justice.

Solemnly affirm at Chennai ] Before Me

On this the day of 2024 ]
And signed his name in my presence ] Advocate
 BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL AT

Thiruvallur

[Link]. of 2024

1] [Link] age 63
F/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,Abirami Madam,
Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
2] Gowri age 53
M/o Deceased Ganjendran.
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203.
3] Minor Pattu age 12
Represent by her Gurdian father Munusamy
No.30-31 Senjiyamman Nagar,
Abirami Madam, Kadapakkam Village
, Kattur Post,Siru Payaverkadu,
Ponneri Taluk ,Tiruvallur-601203
…. Claimants /Petitioner
-Vs-
1] [Link] S/o Ponnu Muthu,
No 4 Bajana Koil Street, Pulicat, Ponneri , Thiruvallur- 601205
2] The Manager -Reliance GIC LTD
H Block 4th Street, Door No.12,
H 2035,15 th Main Raod
Annanagar West, Chennai-600101. ……Respondents

VERIFYING AFFIDAVIT [Link]

I, [Link] age 63,F/o Deceased Ganjendran, No.30-31 Senjiyamman

Nagar,Abirami Madam, Kadapakkam Village, Kattur Post,Siru Payaverkadu, Ponneri
Taluk ,Tiruvallur-601203, do hereby solemnly affirm and sincerely states as follows:

1] I am the deponent herein and the 1th petitioner in the above MCOP and as such I am
well aware of the facts of the case stated hereunder.

2] I submit that I am swearing this affidavit on behalf of me and behalf of the other
petitioners who are none else than my wife and Daughter respectively.

3] I submitted that I had filed the claim petition for the reliefs that has been set out at the
petition thereon. For better appreciation of the fact, the pleading in the plaint may be treated
as part and parcel of this affidavit of mine.

4] I stated declare What are all stated in the claim petition are true and correct to the best of
my knowledge and belief.

Solemnly affirm at Chennai ] Before Me

On this the day of 2024 ]
And signed his name in my presence ] Advocate
 BEFORE THE MOTOR ACCIDENT CLAIMS TRIBUNAL AT

Thiruvallur

[Link]. of 2024

1] Munusamy

Signature Thumb Impression Adhar No

2] Gowri

Signature Thumb Impression Adhar No

3] Pattu
Signature Thumb Impression Adhar No

Petitioner Advocate

BEFORE THE MOTOR ACCIDENT CLAIMS

TRIBUNAL AT CHENNAI

[Link]. of 2024

Munusamy and Others

….Claimants
-Vs-
Pushparaj and another
……Respondents

PETITION UNDER SEC.166 OF [Link] &

RULE 3 OF MACT RULES
 [Link]
M. GAJENDRAN
M. ANBURASAN
Counsel for Petitioner