Consumer Case for Vehicle Insurance Claim

Consumer Case for Vehicle Insurance Claim

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.

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 _____

Deponent

Power of Attorney for Bank Authority (Death Case)

Power of Attorney for Bank Authority

(Death Case)

POWER OF ATTORNEY

KNOW ALL men these present that We, (1) _____ (2) _____  (3) all sons/daughters of late _____ son of _____ All resident of _____, do hereby  appoint our mother _____ as our Attorney in our name and on our behalf  to do or execute  all or of the acts or things.

 Whereas late _____ has with the following accounts with _____ Bank,  _____.
Whereas he has expired on _____, leaving behind the following legal heirs.
(1_____ (2) _____ (3) _____ all sons/daughters of late _____ son of _____ & (4) _____widow of late _____All resident of _____,

DETAILS OF ACCOUNT OF DECEASED

And whereas we cannot present ourselves to receive our share in the said amount and give discharge to the Bank.

 By virtue of this Power of Attorney, the same nominated Attorney will do the following acts i.e. to say.

1. To receive out share in the said amount lying with _____.

2. To give receipt and proper discharge to the Bank connection with the above amounts received on our behalf.

3. To execute Indemnity Bond and arrange for surety in respect of our share in the said amount received.

4. Generally to so all lawful acts necessary for receiving of the said amounts from the Bank.

     And we hereby agree that tall acts, deed and things lawfully done by our said attorney shall be deemed as acts deeds and things done by us personally and we undertake to ratify and confirm all and whatsoever that our said attorney shall lawful do or cause to be done for us by virtue of power hereby given and that no binding on us.

In witnesses where we signed this deed on this _____ day of _____.

EXECUTANTS

Witnesses:
1.
2.

Declaration Form For New Domestic Gas Connection

Declaration Form For New Gas Connection

(For Domestic Use)

DECLARATION

 I, _________ son of _________, age _________, Resident of _________ desire to take domestic LPG connection in my name & affirm as under:-

1.    That I am _________ Citizen.

2.    That my date of birth is _________.

3.    That neither I nor any other member of the household possesses any LPG connection from _________ for domestic use.

4.     That I am enclosing a copy of ration card no. _________ including my name.

5.    I confirm that the LPG connection issued to me will be used in my above mentioned address and for domestic cooking purpose only & I shall abide by all terms governing its use.

6.    That I shall not any other LPG installations in the same kitchen.

7.    That as and when second cylinder issued to me against this connection the same will also be used in the same kitchen and with the original installation

I hereby declare that whatever has been stated above is true to the best of my knowledge correct and nothing material has been concealed there from.

Date: _________                                                                                                                                                Signature: _________

Place: _________                                                                                                                                               Name: _________