1

IN THE COURT OF THE DISTRICT & SESSIONS JUDGE AT UDUPI

ADDITIONAL M.A.C.T. AT KUDNAPURA
M.V.C.No. /2018
Between:
K.N.Prabhakara @KN Prabhakara
-Achari(59 Years)
S/o.Narasimha Achari
R/o.#2-47/1, P.Kalinga Rao Road Petitioner
Pandeshwara, Sasthana Village & Post
Brahmavara Taluk
Udupi District-576226

AND

1.
Harsha Kundar (43 Years)
S/o.Laxmana Suverna
R/a. # 1-79B, Shri Rama Raksha
Kankeri, Opp.Divine Park
Gundmi Village & Post, Airody
Brahmavara Taluk, Udupi Dt-576226
Also R/a.
Vajrakshi Nilaya, Hosabengre Post Respondents
Kodi Kanyana Village, Brahmavara Taluk
Udupi District-576218

2. United India Insurance Co.Ltd

Rep by its Present Branch Manager,
Branch Office, Saligrama Branch
Mantapa, Srinivasa,Nilaya,Ground Floor
Near NH.66&Near Saligrama Bus Stop,
Brahmavara Taluk,Udupi District-576225

POLICY No.2405813118P101364450 Valid From 27/04/2018 to 26/04/2019

APPLICATION FILED UNDER SECTION 166 OF INDIAN
MOTOR VEHICLES ACT 1988 AND APPLICATION IN FORM
NO. 63 (RULE 232) OF THE KARNATAKA MOTOR VEHICLE
RULES 1989.
The petitioner above named begs to submit as follows:
I. I, K.N.Prabhakara @KN Prabhakara Achari, Aged 59 Years,
permanent resident of above address, do hereby apply for
grant of compensation for the injuries sustained by me,
in a Motor Vehicle Accident.
II. Necessary particulars regarding the vehicles involved in
the accident are furnished herein below.
1. Name and father’s name of the K.N.Prabhakara @KN Prabhakara
claimant Achari (59 Yrs)
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S/o.Narasimha Achari
2. Full address of the person As detailed in the cause title
injured
3. Age of the person injured 59 years
4. Occupation of the injured Blacksmith and Centring Work
person Mason
5. Name and Address of the Self Employment
Employer of the injured
6. Monthly income of the injured Rs.20,000/-

7. Does the person in respect of No

whom compensation is claimed
was paying income tax?
8. Place, Date, and time of the Opposite Parvathi Jewelers
Accident Near NH.66, Pandeshwara Village
Udupi District
Date:30/04/2018,Time:11.30AM
9. Brief particulars of the accident In detail in Para III (a)

10. Name and Address of the police Kota Police Station in Crime
station in whose jurisdiction, No.108/2018
the accident took place was
registered
11. Was the person in respect Yes
whom compensation claimed The petitioner K.N.Prabhakara
travelling in the vehicle involved @KN Prabhakara Achari was
in the accident? travelling as a pillion rider in a
If so give the name of place of motor cycle bearing Vehicle Reg
starting of journey and No.KA-14-EQ-1810 and the said
destination motor cycle was stopped near
Parvathi Jewellers of
Pandeshwar Village
12. Nature of injuries sustained, As detailed in the Wound
Continuing affect if any of the Certificate Enclosed
said injury, whether it caused
permanent disablement?

13. Name and Address of the 1)Dr.Shankar.M.Bakkanavar

Medical Officer who attended KMC Reg.No.63093
the injured Associate Professor
Forensic Medicine 7 Toxicology
Clinical Forensic Medicine Unit
KMC Hospital Manipal-576104
2)Dr.Nishanth.A
KMC Hospital Manipal-576104
14. Period of treatment and Initially admitted and Treated in
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Expenditure incurred thereon as an inpatient at Mahesh

Hospital at Brahmavara on
30/04/2018 and as per the
suggestion of the treated doctors
therein he was shifted to KMC
Hospital Manipal and he was
admitted as an inpatient therein
kept in ICU Observations and
was treated there from
30/04/2018 to 15/05/2018 for
about 16 days and then again he
was admitted therein in the KMC
Hospital Manipal from
19/06/2018 to 27/06/2018 for
about 9 days, hence over all the
petitioner was treated for about
25 days in the said hospital
The petitioner has already spent
a sum of Rs 2,50,000/- (Rupees
Two Lakh Fifty Thousand
Only)towards the medical
expenses
15. Registration No,.& type of Hyundai Xcent Car Bearing
vehicle involved in the accident Vehicle Reg No.KA-20-MA-8529
16. Name and address of the Owner 1st Respondent
of the vehicle
17. Name, Policy No. , Insurance 2nd Respondent
particulars and address of the Policy Number:
insurer of the vehicle? 2405813118P101364450 VALID
FROM 27/04/2018 to 26/04/2019
18. Name and address of the Driver 1st Respondent(the 1st respondent
of the Vehicle himself driving the motor
vehicle(Car) belonging to himself)
---------------------------------------
Harsha Kundar (43 Years)
S/o.Laxmana Suverna
R/a. # 1-79B, Shri Rama Raksha
Kankeri, Opp.Divine Park
Gundmi Village & Post, Airody
Brahmavara Taluk, Udupi Dt-
576226
Also R/a.
Vajrakshi Nilaya,Hosabengre Post
Kodi Kanyana Village,
Brahmavara Taluk,
Udupi District -576218
Mob:9986867910
19. Has any claim been lodged with No
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the owner/insurer of the

vehicle?

20. Name and address of the As Detailed in the cause title

applicant? above
21. Relationship with the injured? Does not arise

22. Title to the property of the Does not arise

injured?

23. Amount of Compensation Rs.43,50,000/-

Claimed? And Basis thereof
24. Whether the report from the Report from the police is annexed
Police and the report from the and report from the registering
Registering Authority haveauthority not annexed as it is
been? not available at present and will
If so to be annexed? be produced during the trail of
the case
25. Whether the affidavit from the Annexed
Applicant/Witness as per rule
232© are annexed?
26. Whether documents mentioned Annexed, as detailed in the
in Rule 232© are being documents
annexed?
Duly indexed?

27. Any other information that may

be necessary or helpful in the -
disposal of the claim?
III.
A) That on 30/04/2018 at about 11.30AM, the petitioner
being the pillion rider along with the rider of the motor
cycle bearing vehicle Reg No.KA-14-EQ-1810 came from
Pandeshwara road and both were standing near the
Parvathi Jewellers of Pandeshwara Village of
Brahamavara Taluk which is situated to the left side of
the Kundapura to Udupi NH.66 along with their motor
cycle and at that time a Car bearing Vehicle Reg.No.KA-
20-MA-8529, coming from Kundapura side to Udupi
Side, driven by its driver i.e. 1 st Respondent himself, in a
very high speed, rash and negligent manner without
following any traffic rules , came to the extreme left side
of the said road and dashed against the bike of the
petitioner from the front side , due to the said impact the
petitioner along with the bike and its rider fell down to
the road nearby and sustained grievous injuries as
detailed in the wound certificate produced herewith.
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B) That the accident occurred solely due to the high speed,

rash and negligent and careless driving of the driver (1 st
Respondent himself) of the Car bearing Vehicle Reg.No.KA-
20-MA-8529 belonging to the 1 st Respondent, i.e. he
himself, who was driving the said Car in a high speed and
in a very rash and negligent, careless manner violating
every traffic rules and without observing the traffic rules
and without proper care circumspection and vigil.

C) That the petitioner was immediately lifted to the nearby

Mahesh Hospital at Brahmavara in a hired vehicle and he
was given first aid therein, and thereafter as per the
suggestion of the treated doctors therein, the petitioner
was immediately shifted to the KMC Hospital , Manipal in
a hired vehicle , and therein he was admitted as an
inpatient from 30/04/2018 and was treated for the said
injuries sustained by him in the said accident , his
wounds were cleaned, medicated and bandaged and he
was given various treatments and he underwent various
surgeries and X-Rays for the fracture injuries were taken
and he was inserted rod implant for the fracture of the
right leg and he was given various treatments and various
clinical evaluations were done for the said injuries and he
was given analgesic antibiotics and then discharged on
15/05/2018 from the said KMC Hospital and again he was
re-admitted to the said KMC Hospital Manipal on
16/06/2018 and was given various treatments and then
discharged from the said hospital on 27/06/2018, hence,
the petitioner was admitted as an inpatient in the KMC
Hospital Manipal for about 25 days and have taken
various treatments Thus, in all petitioner has spent sum
of Rs.2,50,000/-(Rupees Two Lakh Fifty Thousand
Only) towards medical expenses. And still he is under
treatment, and he is still bed ridden and cannot even
stand, sit or walk of his own and is having a need of
assistant for his routine activities and the doctors treated
him have suggested him to take constant outpatient
treatment and review along with x-ray and scanning
checkups as well as the need future treatment and
surgeries. He may require more than Rs.1,00,000/-
(Rupees One Lakh Only) for his future treatment and
surgeries etc as suggested by his treated doctors.

D) That the petitioner spent a sum of Rs.1,00,000/-

(Rupees One Lakh Only) towards nursing and attendant
charges and Rs.60,000/-(Rupees Sixty Thousand Only)
towards food and extra nourishment. That, the petitioner
also spent sum of Rs.40,000/-(Rupees Fourty Thousand
Only) towards conveyance charges.
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E) That the petitioner was quite hale and healthy and

had a well built physique at the time of the
accident. And was aged 59 years. He was working as a
Black Smith and also as a Centring Work Mason, and he
was earning more than Rs.20,000/- (Rupees Twenty
Thousand Only)per month. Due to the accidental injuries
he could not able to attend or do his work thereby he had
lost his income. The accidental injuries resulted on the
mental anguish of greatly impaired general health
of the petitioner. The petitioner has undergone heavy
pain and sufferings. The injuries have taken away the
amenities of the petitioner. Due to the accidental injuries
the petitioner sustained permanent disablement. The
petitioner has lost prospective hopes in his employment.
His treatment is not yet completed. Thus on a prudent
and reasonable estimation the petitioner has sustained
general damages to the tune of Rs.38,00,000/- (Rupees
Thirty Eight Lakhs only) inclusive of damages towards
pain and sufferings, loss of amenities of life, loss of
income, loss of future earnings, loss of future
expectations of life, etc.

IV. Therefore it is prayed that the 1 st respondent as the

owner and the 2nd respondent as the insurer of the car
bearing Vehicle Reg.No.KA-20-MA-8529, are liable to
pay jointly and severally a sum of Rs.43,50,000/-
(Rupees Fourty Three Lakhs Fifty Thousand Only)
towards damages sustained by the petitioner along
with interest at the rate of 12% per annum from
the date of accident till realization.

V. Hence it is prayed that the Honourable Court may

be pleased to pass an award against the respondents
for the following relief’s.
1. Directing them to pay a sum of Rs. Rs.38,00,000/-
38,00,000/-(Rupees Thirty Eight Lakhs
Only) towards the general damages.
2. Directing them to pay a sum of Rs. Rs.2,50,000/-
2,50,000/-(Rupees Two Lakh Fifty
Thousand Only) towards medical
expenses
3. Directing them to pay a sum of Rs. 40,000/-
Rs.40,000/-(Rupees Fourty Thousand
Only) towards conveyance charges
4. Directing them to pay a sum of Rs. Rs. 1,60,000/-
60,000/-(Rupees Sixty Thousand
Only) towards food and extra
 7

nourishment & Rs.1,00,000/-(Rupees

One Lakh Only) towards nursing and
attendants charges

5. Directing them to pay a sum of Rs.1,00,000/-

Rs.1,00,000/-(Rupees One Lakh
Only) towards future medical
treatment charges

6. Directing them to pay interest over

the above sum at the rate of 12% p.a.
from the date of the accident till
realization & to pass such other
reliefs. Rs.43,50,000/-
Total

Place: Udupi
Date: - -2018 Advocate for the Petitioner Petitioner

I, the above named petitioner do hereby declare that

what is stated herein above are all true and correct to
the best of my knowledge, belief and information.

Place: Udupi
Date: -2018 Petitioner

VERIFICATION
Verified at Kundapura on this …… day of _____________2018,
that the contents of the above application are true and correct
to my knowledge and belief.

Kundapura.
Date: - -2018 Petitioner
LIST OF DOCUMENTS FILED ON BEHALF OF PETITIONER
1. True copy of the FIR and complaint.
2. True Copy of the Charge Sheet of Final Report
3. True copy of the Spot mahazar.
4. True copy of the wound certificate
5. True copy of the IMV report.
6. True Copy of the Accident Information Report Register issued
by Kota Police Station in Cr.No.108/2018
 8

7. Notarized copy of the Family Ration Card of the petitioner

8. Notarized copy of the Aadhaar Card of the petitioner
9. Notarized copy of the Vehicle Insurance Policy Issued by the
2ND Respondent to the Motor Vehicle/Car of the 1 st Respondent
bearing Vehicle Reg No.KA-20-MA-8529 bearing Policy
No.2405813118P101364450 valid from 27/04/2018 to
26/04/2019

Place: Udupi
Date: - -2018 Advocate for the Petitioner
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IN THE COURT OF THE DISTRICT & SESSIONS JUDGE AT UDUPI

ADDITIONAL M.A.C.T. AT KUDNAPURA
M. V. C. No. /2018
Between :
K.N.Prabhakara @KN- } -------Petitioner
-Prabhakara Achari }
AND
Harsha Kundar }
& another } ----- Respondents

AFFIDAVIT
I, K.N.Prabhakara@K.N.Prabhakara Achari aged about 59
years, S/o.Narasimha Achari, residing at Door No.2-47/1,P.Kalinga
Rao Road, Pandeshwara, Sasthana Village& Post, Brahmavara
Taluk, Udupi Dt.,-576226, do hereby solemnly affirm and oath as
follows:
1) I say that I am the deponent herein and the guardian of
the petitioner in the above case

2) I say that, I have filed above petition against Respondents

for compensation of the injury sustained by me in a road
traffic accident.

3) I say that, averments made in the above petition are all true
and correct to the best of knowledge, belief and information.

4) I say that, I have not preferred any claim application or

petition preferred any compensation with regard to the
cause of action of my above said petition or road traffic
accident met by me as stated in my petition

5) I say that, I have duly instructed my counsel to prepare the

above petition and I have signed the same after due
verification and found to be in accordance with my
instructions.

6) I say that, facts stated herein above are all true and correct.

Place: Udupi
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Dated: - -2018 DEPONENT

Identified By Me:-

IN THE COURT OF THE DISTRICT & SESSIONS JUDGE AT UDUPI

ADDITIONAL M.A.C.T. AT KUDNAPURA
M. V. C. No. /2018
Between :
K.N.Prabhakara @KN- } -------Petitioner
-Prabhakara Achari }
AND
Harsha Kundar }
& another } ----- Respondents

LIST OF DOCUMENTS FILED ON BEHALF OF PETITIONER

1. True copy of the FIR and complaint.
2. True Copy of the Charge Sheet of Final Report
3. True copy of the Spot mahazar.
4. True copy of the wound certificate
5. True copy of the IMV report.
6. True Copy of the Accident Information Report Register issued
by Kota Police Station in Cr.No.108/2018
7. Notarized copy of the Family Ration Card of the petitioner
8. Notarized copy of the Aadhaar Card of the petitioner
9. Notarized copy of the Vehicle Insurance Policy Issued by the
2ND Respondent to the Motor Vehicle/Car of the 1 st Respondent
bearing Vehicle Reg No.KA-20-MA-8529 bearing Policy
No.2405813118P101364450 valid from 27/04/2018 to
26/04/2019

Place: Udupi
Date: - -2018 Advocate for the Petitioner
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IN THE COURT OF THE DISTRICT & SESSIONS JUDGE AT UDUPI

ADDITIONAL M.A.C.T. AT KUDNAPURA
M. V. C. No. /2018
Between :
K.N.Prabhakara @KN- } -------Petitioner
-Prabhakara Achari }
AND
Harsha Kundar }
& another } ----- Respondents

PROCESS FEE MEMO/BATTA MEMO

It is submitted that;
The counsel for the Petitioner has paid the
process fee of Rs. 16-00 is herewith. That this
Honorable Court may be pleased to issue Notice to the
respondents through RPAD in the above case.

1. Harsha Kundar (43 Years)

S/o.Laxmana Suverna
R/a. # 1-79B, Shri Rama Raksha
Kankeri, Opp.Divine Park
Gundmi Village & Post, Airody
Brahmavara Taluk, Udupi Dt-576226……………….8.00
Also R/a.
Vajrakshi Nilaya, Hosabengre Post
Kodi Kanyana Village, Brahmavara Taluk
Udupi District-576218

2. United India Insurance Co.Ltd

Rep by its Present Branch Manager,
Branch Office, Saligrama Branch
Mantapa, Srinivasa,Nilaya,Ground Floor……………….8.00
Near NH.66&Near Saligrama Bus Stop,
Brahmavara Taluk, Udupi District-576225

======
Total Rs. 16=00
======
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Place: Udupi
Date: - -2018 Advocate for the Petitioner

C.P.C.(100) I.A. NOTICE IN C.M.P.

In the Court of the M.A.C.T at Kundapura
M. V. C. No. /2018
Between :
K.N.Prabhakara Achari@KN- }---Petitioner
-Prabhakara Achari }
AND
Harsha Kundar }
& another }--Respondents

To
R1,
Harsha Kundar (43 Years)
S/o.Laxmana Suverna
R/a. # 1-79B, Shri Rama Raksha
Kankeri, Opp.Divine Park
Gundmi Village & Post, Airody
Brahmavara Taluk, Udupi Dt-576226
Mobile No:9986867910/9920653910

Whereas the above named...................................................has

made application to this court that …………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………

You are hereby warned to appear in this court in person or by a

pleader duly instructed, on the ………….day of …………20……..
At 11 O’ clock in the forenoon to show cause against the
application falling which the said application will be heard and
determined exparte.

Given under my hand and seal of the Court this ………………..

day of …………………………….. 2018.

(By order of the court)

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Advocate for Petitioner Central Nazir

C.P.C.(100) I.A. NOTICE IN C.M.P.

In the Court of the M.A.C.T at Kundapura
M. V. C. No. /2018
Between :
K.N.Prabhakara Achari@KN- }---Petitioner
-Prabhakara Achari }
AND
Harsha Kundar }
& another }--Respondents
To
R2,
United India Insurance Co.Ltd
Rep by its Present Branch Manager,
Branch Office, Saligrama Branch
Mantapa, Srinivasa,Nilaya,Ground Floor
Near NH.66&Near Saligrama Bus Stop,
Brahmavara Taluk, Udupi District-576225
Tel:-0820-2564060/+91-9448108233

Whereas the above named...................................................has

made application to this court that …………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………
…………………………………………………………………………………

You are hereby warned to appear in this court in person or by a

pleader duly instructed, on the ………….day of …………20……..
At 11 O’ clock in the forenoon to show cause against the
application falling which the said application will be heard and
determined exparte.

Given under my hand and seal of the Court this ………………..

day of …………………………….. 2018.

(By order of the court)

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Advocate for Petitioner Central Nazir

IN THE COURT OF THE DISTRICT & SESSIONS

JUDGE AT UDUPI AND ADDL. M.A.C.T AT
KUNDAPURA
M. V. C. No. /2018
Between :
K.N.Prabhakara@KN- }
-Prabhakara Achari } ----- Petitioner

AND
Harsha Kundar }
& another } ----Respondents
INDEX
Sl.N Description Pages C.F.
o Paid
1) Petition with verification Rs.10/-

2) Affidavith

3) Vakalath

4) Process Fee Memo/Batta Memo Rs.16/-

5) List Of Documents(Originals)

6) Copy of the Petition(2 sets)

7) List Of Documents(True Copy)

TOTAL
Rs.26/-
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Place: Kundapura
Date: - -2018
Advocate for the Petitioner

IN THE COURT OF THE ADJ/SCJ AND ADDL.

M.A.C.T AT KUNDAPURA
M. V. C. No. /2018
Between :
Laxmana Kulal@ Laxmana } ----- Petitioner
}
AND
Hussainar.K }
& another } ----- Respondents
 16

BY RPAD/BY RLAD

To:-
Hussainar K(63 Years)
S/o.Late Mulla Ahamed Nainar Saheb
R/a. Khateeja Manzil
M.Kodi, Kodi Kasba, Kodi Kasba Post
Kundapura Kasba Village
Kundapura Taluk, Udupi Dt-576217
Mobile No:8971073839

BY RPAD/BY RLAD

To:-
ICICI Lombard General Insurance Co.Ltd
Rep by Branch Manager,
Branch Office, Bangalore
Second Floor, SVR Complex-28
Hosur, Main Road, Madivala, 1st Stage
Koramangala,Bangalore-560068
17