Consumer Case on Vehicle Insurance

Consumer Case on Vehicle Insurance
BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES REDRESSAL FORUM,_______

 Complaint No._____ of _____ Under Consumer Protection Act _____

_______________(Complainant)

Versus
_______________(Respondents)

Complaint under section _____ of the consumer Protection Act, _____

EVIDENCE BY WAY OF AFFIDAVIT OF THE COMPLAINANT
I, _____ son of _____ resident _____ at present Resident of _____ do hereby solemnly affirm and declare as under:- 

  1. That the deponent is the consumer of the respondent as defined under the consumer protection Act, _____. 
  2. That the deponent is the registered owner of the vehicle _____ bearing its Registration No. _____ Engine No. _____, Chassis No. _____, Model _____. The said vehicle was get insured by the deponent with the respondent insurance company vide insurance policy No. _____ which was valid with effect from _____ to midnight of _____ covering all type of risks therein. As per the insurance policy issued by the respondent to the deponent , the said vehicle was get insured for the amount of _____/- (_____) . A photocopy of the insurance policy and a photocopy of Registration Copy of _____ No. _____ are exhibited herewith as _____.  
  3. That at the time of issuance of the above said insurance policy, the respondent had assured the deponent that the respondent would pass insurance claimed and make the payment of the claimed amount immediately, if the said vehicle will meet with accident or will be stolen at any point of time with in the validity period of the said insurance policy . 
  4. That in the mid night of _____ at about _____. The deponent parked his above said _____ in front of _____ in _____, but the said vehicle was stolen by someone in the night of _____. The deponent searched the said vehicle everywhere, but the where about of the said vehicle were not traced by the deponent. Hence the deponent got registered the FIR in the police station _____ bearing its FIR No. _____, dated _____ U/S. _____IPC regarding the theft of the said _____ against unknown thief. The copy of the FIR is exhibited herewith as _____. 
  5. That just after the steeling of the said vehicle of the deponent intimated the respondent and also submitted the FIR and all the relevant documents to the respondent regarding the steeling of the said vehicle. 
  6. That then after the deponent approached the respondent and requested to make the payment of the insured amount by raising the insurance claim in the office of the respondent. In this regard the respondent had issued the claim no. _____ and the respondent demanded the copy of the untraced report or final report from the deponent on _____. 
  7. That upon the application of the deponent the Hon’ble court of _____, has declared the above-mentioned vehicle as untraced vide its order dated _____. The copy of the order dated _____ is exhibited herewith as _____. 
  8. That then after the deponent personally visited the office of the respondent and met with the respondent and again approaching for claim in writing and submitted the final report along with the copy of the untraced report, photocopy of insurance policy , copy of the FIR, NCR Report, and copy of the R.C. of the said vehicle vide application dated _____. 
  9. That the respondent being the insurer of the above mentioned vehicle of the deponent and the above said vehicle has been stolen in the validity period of insurance policy, hence the respondent is liable and duty bound to pay the insurance claim as per the terms and conditions of the said policy to the deponent as soon as, but the respondent is trying to escape from their responsibility and liability to make the payment of the claimed amount to the deponent in arbitrary manner, hence the deponent is legally entitled to recover the amount of insurance claim along with interest from the respondent as per the terms and conditions of the insurance policy . 
  10. That the cause of action to file the present complaint accrued on each and every date when the deponent requested the respondent to make the payment of the insurance claimed amount and the cause of action finally accrued on _____ when the respondent has finally refused to make the payment of the insurance claimed amount to the deponent. 
  11. That the relevant documents which are produced before this Hon’ble Forum may kindly be read in my evidence. 

Deponent 
Verification: Verified that the above contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein
Verified at _____ on _____

Deponent

Application to entertain Apeal

Application to entertain Apeal
IN THE COURT OF _____

_____ Versus _____

APPEAL APPLICATION FOR ENTERTAINING THE APPEAL WITHOUT THE CERTIFIED COPY OF THE NOTICE UNDER SECTION _________ BEARING ITS MEMO NO. _______ DATED. _____ 

RESPECTFULLY SHOWETH:

  1. That the applicant /appellant is filing the above mentioned appeal _____ before this Hon’ble court. 
  2. That the applicant /appellant have no certified copy of the above mentioned Memo with him and he has been filing the photocopy of the same along with the present appeal. 
  3. That the applicant will deposit the certified copy of the said Memo within the period of _____ days. It is, therefore, prayed that the above mentioned appeal may kindly be accepted without the certified copy of the above mentioned Notice in the interest of justice. 



Dated: _____ 





APPELLANT 


Through Counsel 


_____ Advocate, _____

Application for Adjournment of the Case

Adjournment of the Case
IN THE COURT OF _____

In the matter of:
_____ Versus _____

FIR NO. _____ U/s _____IPC Police Station _____


APPLICATION FOR ADJOURNMENT OF THE CASE 

RESPECTFULLY SHOWETH:

  1. That the above noted case is pending before this hon’ble court and is fixed for today. 
  2. That the counsel of the accused is _____ from _____ and is not in position to appear before this Hon’ble court. 
  3. That now the applicant wants to get adjourned the above noted case for next date of hearing. It is, therefore, prayed that the above noted case may kindly be adjourned for next date of hearing Date: _____ 


APPLICANT/ACCUSED 



Through Counsel: 


_____Advocate, _____

Amendment in Date of Birth Certificate

Amendment in Date of Birth Certificate
AFFIDAVIT

I ___ son of ____ R/o ____ do hereby solemnly affirm and declare as under:-

  1. That the deponent was born in ____ Hospital, ____ on ____ and the birth event of the deponent was recorded in the said Hospital on the same vide Serial No. ____. The photocopy of the Receipt issued by the Hospital is enclosed herewith as Annexure –A. On the basis of which the date of birth of the deponent was recorded in office ____ of Birth & Death City Zone ____ vide birth registration dated ____. Thus the actual and correct birth of birth of deponent is ____ (In Words____). The photocopy of the Birth Certificate is enclosed as Annexure –B. 
  2. That at the time of admission of the plaintiff in the first class in the School the ____ of the plaintiff due to some confusion got mentioned the date of birth the plaintiff as ____ instead of ____. 
  3. That the plaintiff passed Middle exams in the year ___, matriculation examinations in the year ____ and the incorrect date of birth of the plaintiff i.e. ____ continued in the records of middle, matriculation and senior secondary exams. The photocopies of the marks-sheets of matriculation and senior secondary are enclosed as Annexure- C & D. 
  4. That suddenly in the month of ____the plaintiff found the original birth records of the ____ and Hospital receipt then the plaintiff came to know that his actual date of birth was ____. After that the plaintiff verified the records and came to know about his correct date of birth. 
  5. That the deponent wrote a letter dated ____ for correction of his date of birth into the educational records to the ____ and other authorities for the correction of the date of birth in the relevant educational records of the deponent. The photocopy of letter dated ___, postal receipt and reply dated ____ are enclosed as Annexure –E to G. 
Deponent 

Verification : Verified that the contents of my above affidavit are true to best of my knowledge and belief and nothing has been concealed therein. 
Verified at ____ on ___________ 
Deponent

Special Power of Attorney

Special Power of Attorney
SPECIAL POWER OF ATTORNEY

I, _____ son of ______ , Resident of _____, at present Resident of ______, hereby appointed and designate to my real ____, resident of _____, as my attorney through this SPECIAL POWER OF ATTORNEY pertaining to my ____ share in the property No. ____ since being ___,
I legally authorized ____ son of/wife of ____ to execute sale deed in the office of Sale registrar in ____ or any appropriate office pertaining to my ____ share in the sited house property.

I shall be bind by all the above sited power exercise by ____ in the capacity of my SPECIAL ATTORNEY pertaining to the above sited house property in ____ EXECUTANT ____ S/o/D/o ___, at present, R/o ____

Witnesses:
1.___________________

2.___________________

Correction in Power of Attorney

Correction in Power of Attorney
IN THE COURT OF ___________________

__________COMPALINANT VERSUS__________ACCUSED

COMPLAINT UNDER SECTION ___ OF THE ___ ACT

Application for submission of a fresh power of Attorney to remove the technical mistake i.e. ____ Instead of ____ in the Power of Attorney filed earlier with the above said complaint. RESPECTFULLY SHOWETH:
  1. That the above noted complaint is pending before this Hon’ble court and is fixed for ____.
  2. That as General Power of Attorney holder of ____, the complainant filed a complaint under section ____ of the ____ Act on ___ against ____ accused/respondent in the court of ____ the then ___
  3. That due to the oversightness or by typographical mistake the name of the company was mentioned as ____ instead of ____ in the Power of Attorney dated ____ which was registered on ____ but when it came to the knowledge of the complainant he got a fresh General Power of attorney from _____. So it is a technical mistake kindly allowed the complainant for submitting the fresh General Power of Attorney in the present complaint.
  4. That in the interest of justice the complainant it is necessary to allow the applicant /complainant to replace the fresh Power of Attorney in the above said complaint so that the complainant may not suffer irreparable loss.
PRAYER
It is, therefore, prayed that the applicant may kindly be allowed to submit a fresh Power of Attorney in place of previous one and further allowed that it should be read in the evidence i.e. ____ in place of ____ in the interest of justice.
Dated _______                                                               APPLICANT/COMPLAINANT
Through counsel

ADVOCATE

Change of Name

Change of Name
AFFIDAVIT

I, _____ son of ______, resident of ______ do hereby solemnly affirm and declare as under :-

  1. That my name has been recorded as ____ in all the educational certificates and in other relevant documents etc. 
  2. That now I have changed my name as ______ in place of my previous name _____.
  3. That in future I will be known by my new name i.e. ______ in future for all purposes. 

 Deponent 

Verification:- 
Verified that the above contents of this affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein. 
Verified at ______ on ____ 
Deponent

Declaration for Changes in Signature

Declaration for Change of Signature
AFFIDAVIT 

I, __________ son/daughter/spouse of _____________ aged ___, residing at _______________, do hereby solemnly affirm and declare as under: 


  1. That I, Shri/Smt ___________, having signature now to be changed as copy of specimen is attached. 
  2. That I, am residing at the abovementioned address and have not changed my address in the past three years. OR I am residing at the abovementioned address for the past (period of time at the present address) and before that I was staying at (the earlier address ) for (period of time at the earlier address). 
  3. That I have changed my signature. 
  4. I hereby affirm that after dated _________ all the signature done by me i.e. ________________ will be as no. 2 done on specimen copy attached with affidavit and any signature done with no.1 will not considered as mine.

I am executing this declaration to be submitted to the concerned authorities for the change of signature. 

I hereby state that whatever is stated herein above are true to the best of my knowledge. 

Solemnly affirmed at ________ ) 
On this ____ day of ______ 2004 ) 

(Signature of the Applicant)
Deponent 
Identified by me Before Me

Advocate S.E.M./ Oaths Commissioner/Notary

Important Note:

  • Affidavit should be on Non-judicial stamp paper of Rs.100/-.
  • Please do not just type this format as it is. 
  • Affidavit should be attested by Notary/S.E.M/ Oaths Commissioner

Suit for Declaration of Agriculture Land

Suit for Declaration Agriculture Land
IN THE COURT OF CIVIL JUDGE, _____________.


___________   Versus    _________ 

SUIT FOR DECLARATION.
 AFFIDAVIT 

I __________ son of Shri ________ R/o ___________ do hereby solemnly affirm and declare as under :-
  1. That the defendant is recorded as owner of the following agricultural lands:- 
           (a) to extent of ____ share of the agricultural land bearing ____, 
                total measuring ____.
           (b) to the extent of _______ share of the agricultural land bearing ________,
                total measuring ______, 
           (c) to the extent of ____ share of agricultural land bearing ____,
                total measuring __ 
           (d) to the extent of ____ share of agricultural land bearing _____,
                total measuring ____,
                all the lands are situated within the revenue estate of __________. 
                The certified copy of the _____ for the year ____ is enclosed herewith the plaint. 

  1. That the defendant is the ___ of the deponent and the parties to the suit constitute a ___.
  2. That on ____ a family settlement took place between the deponent and the defendant vide which the defendant gave her respective shares of the suit property, mentioned in Paras No.1 (a) to 1(d) of the plaint, in favor of the deponent and since then the deponent is in actual and physical possession of the suit property mentioned in Para No.1(a) to (d) of the plaint. However, the name of the defendant still exists in the revenue records which is wrong and is not binding upon the rights, title and interest of the plaintiff. 
  3. That now the defendant with a malafide intention is not admitting the family settlement and she is also not admitting the claim of the deponent in respect of suit property and by getting recorded her name in the revenue records she is still declaring herself as owner of the suit property for which the defendant has got no right, title and interest to do so. 
  4. That the deponent asked the defendant several times to admit the claim of the deponent and to get the revenue entries corrected/incorporated in the name of the plaintiff. First of all the defendant was avoiding the requests of the plaintiffs on one pretext or the other and finally on _____ refused to accept the legitimate requests of the plaintiff. 
  5. That the cause of action to file the present suit firstly accrued on _______ when the family settlement took place between the deponent and the defendant. It further arose on each and every date when the deponent asked the defendant to admit the claim of the plaintiff. The cause of action finally ____ when the defendant finally refused to accept the claim of the plaintiff. This is the date when the final cause of action has arisen in favor of the deponent and against the defendant, which necessitated the institution of the present suit. 

 DEPONENT 

VERIFICATION: 
Verified that the contents of my above affidavit are true and correct to best of my knowledge and belief and nothing has been concealed therein. 
Verified at ______ on _________ 
DEPONENT

Public Notice for Name Change after Marriage

Change of Name
Ref No……..                                                                                Dated ...........


PUBLIC NOTICE 

 KNOW ALL MEN be notice that my client ________ W/o ________ R/o _________   has given me instructions to issue a Public Notice on her behalf. The name of my said client before her marriage was _______ and after her marriage with her husband _________ she has changed her name as __________. In future she will be known by her present name i.e. by her new name __________ for all purposes.



Advocate_____________________

Address Proof Format

Affidavit of Address Proof 
AFFIDAVIT

 I _____________ (name of the declarant) S/o, D/o___________Resident of _____________ District___________do hereby solemnly affirm and declare as follows: 


  1. That my permanent residence is Mohalla/Village__________ P.O________ P.S________ Ward No_________ Circle No.________ District_________. 
  2. That I require a residential certificate. 


 Deponent 
VERIFICATION: 
Verified that the above said affidavit of mine is true and correct to the best of my knowledge and belief and nothing has been concealed therein. No part thereof it is false. 

Deponent
Place : 
Dated: