Consumer Case for Vehicle Insurance Claim
BEFORE THE PRESIDENT DISTRICT
CONSUMER DISPUTES REDRESSAL FORUM, _____, _____
Complaint No._____ of _____
Under Consumer Protection Act
_____
…..Complainant
Versus
_____ …..Respondents
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.
Verification:-
Deponent
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 _____
Verified at _____ on _____
Deponent
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