1

IN THE COURT OF THE DISTRICT & SESSIONS JUDGE AT UDUPI

ADDITIONAL M.A.C.T. AT KUDNAPURA
M.V.C.No. /2020
Between:
Rangayya Shetty(59 Years) )
S/o.Late Krishnappa Shetty )
R/o.Herikudru, Anagalli )Petitioner
Anagalli Village& Post )
Kundapura Taluk, Udupi Dt )

AND

1. Kiran Nayak (27 Years) )

S/o.Krishna Nayak )
R/a. Door No.2/35, )
Laxmi Damodahara Nilaya )
Mundar Mundi , Nanchur Village& Post )
Udupi Tq & Dt -576234 ) Respondents
)
2. The United India Insurance Co.Ltd )
Rep by its Present Branch Manager, )
Branch Office, Putturu Branch )
Prabhu Building, Opp.Aruna Talkies )
Main Road, Puttur Village& Post )
Puttur Tq, Dakshina Kannada Dt-574201 )

POLICY No.0729023119P107357775 Valid from 11/09/2019 to 10/09/2020

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, Rangayya Shetty, 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 Rangayya Shetty (59 Yrs)
claimant Late Krishnappa Shetty
2.Full address of the person injured As detailed in the cause title
3.Age of the person injured 59 years
4.Occupation of the injured person Coolie and Agricluture
5.Name and Address of the Self Employment
Employer of the injured
6.Monthly income of the injured Rs.13,000/-
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7.Does the person in respect of No

whom compensation is claimed
was paying income tax?
8.Place, Date, and time of the Near Kamalamma Kalyana Mantapa, and
Accident Infront of Nagesh Tailor’s House,
Koteshwara Village& Post, Kundapura Tq,
Udupi Dt
Date:04-12-2019,Time:10.15AM
9.Brief particulars of the accident In detail in Para III (a)

10.
Name and Address of the police Kundapura Traffic Police Station in Crime
station in whose jurisdiction, the No.132/2019
accident took place was
registered
11.
Was the person in respect whom Yes
compensation claimed travelling The petitioner was travelling in a Honda
in the vehicle involved in the Activa Scooter bearing Vehicle Reg.No.KA-
accident?
20-EL-2773 along with his Bharathi Shetty
If so give the name of place of
starting of journey and and was travelling from Kundapura side to
destination Manooru side by wearing
Helmet(Headgear) and was riding the said
scooter in a slow and steady manner by
following all traffic rules

12.
Nature of injuries sustained, As detailed in the Wound Certificate
Continuing affect if any of the Enclosed
said injury, whether it caused
permanent disablement?

13.
Name and Address of the 1)Dr.N.Bhaskar Acharya(Major)
Medical Officer who attended the Consultant Surgeon
injured Dr.N.R.Acharya Memorial Hospital
Koteshwara
Koteshwara Village & Post
Kundapura Tq, Udupi Dt-576222

2)Dr.Pradeep Kumar Shetty.A(Major)

Consultant Orthopedic Surgeon
Dr.N.R.Acharya Memorial Hospital
Koteshwara
Koteshwara Village & Post
Kundapura Tq, Udupi Dt-576222
14.
Period of treatment and The petitioner was shifted from the spot of
Expenditure incurred thereon the accident to the Dr.N.R.Acharya
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Memorial Hospital Koteshwara in a hired

vehicle and was admitted therein as
inpatient from 04/12/2019 to 07/12/2019 for
about 4 days and has already spent a sum
of Rs.2,00,000/- (Rupees Two Lakhs
Only)towards the medical expenses
15.
Registration No,.& type of vehicle Motor Cycle Bearing Vehicle Reg No.KA-
involved in the accident 20-ER-9999
Name and address of the Owner 1st Respondent
16.
of the vehicle

Name, Policy No. , Insurance 2nd Respondent

17.
particulars and address of the POLICY No.0729023119P107357775 VALID
insurer of the vehicle? FROM 11/09/2019 TO 10/09/2020

18.
Name and address of the Driver Damodhara Pai(20 Years)
of the Vehicle S/o.Prakash Pai
R/o.Nandikeshwara Nilaya, Moodugopadi
Gopadi Village& Koteshwara
Post, Kundapura Tq, Udupi Dt-576222
19.
Has any claim been lodged with No
the owner/insurer of the vehicle?
20.
Name and address of the As Detailed in the cause title above
applicant?
21.
Relationship with the injured? Does not arise

22.
Title to the property of the Does not arise
injured?

23.
Amount of Compensation Rs.28,20,000/-
Claimed? And Basis thereof
24.
Whether the report from the Report from the police is annexed and
Police and the report from the report from the registering authority not
Registering Authority have been? annexed as it is not available at present
If so to be annexed? and will 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 documents
in Rule 232© are being annexed?
Duly indexed?
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27.
Any other information that may
be necessary or helpful in the -
disposal of the claim?
III.
That on 04/12/2019 at about 10.15 AM the petitioner was
travelling from Anagalli side to Manoor side in a Honda Activa
Scooter bearing Vehicle Reg.No.KA-20-EL-2773 along with his
wife Bharathi Shetty as the pillion rider and was riding the said
scooter in a slow and steady manner by following all traffic rules
and wearing helmet and when his motor cycle(Scooter)reached
a place Near Kamalamma Kalyana Mantapa , Infront of Nagesh
Tailor House at Koteshwara at that time another motor cycle
bearing Vehicle Reg.No. KA-20-ER-9999 belonging to the 1 st
Respondent ridden by its rider in a very high speed rash and
negligent manner came from the left side and dashed against
the scooter of the petitioner from the front side and due to the
said impact the petitioner along with his wife i.e. pillion rider
and his motor cycle fell down to the road and sustained
grievous injuries as detailed in the wound certificate produced
herewith.

A) That the accident occurred solely due to the high speed, rash
and negligent and careless riding of the rider of the motor
Cycle(Bike) bearing Vehicle Reg.No. KA-20-ER-9999 belonging
to the 1st Respondent, who was riding the said motor Cycle(bike)
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.

B) That the petitioner was immediately lifted to the N.R.Acharya

Memorial Hospital at Koteshwara in a hired vehicle and he was
given first aid therein, and therein he was admitted as an
inpatient from 04/12/2019 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 was undergone X-Rays and Scanning for the injuries
sustained by him in the said accident and he underwent various
surgeries and X-Rays for the fracture injuries were taken and he
was given various treatments and various clinical evaluations
were done for the said injuries and he was given analgesic
antibiotics, and he underwent various surgeries and implant was
implanted and then he was discharged from the said the
N.R.Acharya Memorial Hospital at Koteshwara on 07/12/2019
hence in overall the petitioner was admitted for about
4 days in the above said hospital and have taken various
treatments Thus, in all petitioner has spent sum of Rs.2,00,000/-
(Rupees Two Lakhs Only) towards medical expenses. And still
he is under treatment, and the doctors treated him have
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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.
30,000/-(Rupees Thirty Thousand Only) for his future treatment
and surgeries etc as suggested by his treated doctors.
C) That the petitioner spent a sum of Rs.30,000/-(Rupees
Thirty Thousand Only) towards nursing and attendant charges
and of Rs.30,000/-(Rupees Thirty Thousand Only) towards
food and extra nourishment. That, the petitioner also spent sum
of Rs.30,000/-(Rupees Thirty Thousand Only) towards
conveyance charges.
D) 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 Coolie and Agriculture and
due to the said work he was earning more than Rs.13,000/-
income per month. Due to the accidental injuries he could not
able to attend perform and do his work and he had stopped
doing the said work. 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 career. His treatment is not yet completed. Thus on
a prudent and reasonable estimation the petitioner has
sustained general damages to the tune of Rs.25,00,000/-
(Rupees Twenty Five 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 motor cycle
bearing Vehicle Reg.No.KA-20-ER-9999 are liable to pay
jointly and severally a sum of Rs.28,20,000/-(Rupees Twenty
Eight Lakhs Twenty 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 Honorable 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.25,00,000/-
25,00,000/-(Rupees Twenty Five Lakhs Only)
towards the general damages.
2.Directing them to pay a sum of Rs. Rs.2,00,000/-
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2,00,000/-(Rupees Two Lakhs Only)

towards medical expenses
3.Directing them to pay a sum of Rs. 30,000/-
Rs.30,000/-(Rupees Thirty Thousand
Only) towards conveyance charges
4.Directing them to pay a sum of Rs. 60,000/-
Rs.30,000/-(Rupees Thirty Thousand
Only) towards food and extra nourishment
& Rs.30,000/-(Rupees Thirty Thousand
Only) towards nursing and attendants
charges
5.Directing them to pay a sum of Rs.30,000/-
Rs.30,000/-(Rupees Thirty Thousand
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.
Total Rs.28,20,000/-

Place: Udupi
Date: - -2020 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: -2020 Petitioner
VERIFICATION
Verified at Kundapura on this …… day of May 2020, that the contents
of the above application are true and correct to my knowledge and
belief.

Kundapura.
Date: - -2020 Petitioner
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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.132/2019
7. Notarized copies of the Aadhaar Card & Family Ration Card and Epic
Card of the petitioner

Place: Udupi
Date: - -2020 Advocate for the Petitioner
 8

IN THE COURT OF THE DISTRICT & SESSIONS JUDGE AT UDUPI

ADDITIONAL M.A.C.T. AT KUDNAPURA
M. V. C. No. /2020
Between :
Rangayya Shetty } -------Petitioner
AND
Kiran Nayak }
& another } ----- Respondents

AFFIDAVIT
I, Rangayya Shetty, aged about 59 years, S/o.Late Krishnappa
Shetty, residing Sri Ganesh, Herikudru, Anagalli Village & Post, Udupi
Taluk, Udupi Dt., 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 , other than this application for the claim of

compensation for the accidental injuries , I have not filed any
other application under any acts or under MV act before any court
of MACT tribunals in regard of the said accident.

7) I say that the accident above said was occurred on 04/12/2019

and the present claim application of mine filed by me is within
time of 6 months from the date of its occurrence as prescribed in
the amended MV Act section 166(3) and is within the jurisdiction
limits of this Hon’ble Court.
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8) I say that, facts stated herein above are all true and correct.

Place: Udupi
Dated: - -2020 DEPONENT
Identified By Me:-
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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. /2020
Between :
Rangayya Shetty } -------Petitioner
AND
Kiran Nayak }
& 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.132/2019
7. Notarized copies of the Aadhaar Card & Family Ration Card and Epic
Card of the petitioner

Place: Udupi
Date: - -2020 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. /2020
Between :
Rangayya Shetty } -------Petitioner
AND
Kiran Nayak }
& 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. Kiran Nayak (27 Years) )

S/o.Krishna Nayak )
R/a. Door No.2/35, )
Laxmi Damodahara Nilaya )………..8.00
Mundar Mundi , Nanchur Village& Post )
Udupi Tq & Dt -576234 )
)
2. The United India Insurance Co.Ltd )
Rep by its Present Branch Manager, )
Branch Office, Putturu Branch )………..8.00
Prabhu Building, Opp.Aruna Talkies )
Main Road, Puttur Village& Post )
Puttur Tq, Dakshina Kannada Dt-574201 )

======
Total Rs. 16=00
======

Place: Udupi
Date: - -2020 Advocate for the Petitioner
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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. /2020
Between :
Rangayya Shetty } -------Petitioner
AND
Kiran Nayak }
& another } ----- Respondents

To
R1,
Kiran Nayak (27 Years)
S/o.Krishna Nayak
R/a. Door No.2/35,
Laxmi Damodahara Nilaya
Mundar Mundi , Nanchur Village& Post
Udupi Tq & Dt -576234

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
…………………………….. 2020.

(By order of the court)

Advocate for Petitioner Central Nazir

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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. /2020
Between :
Rangayya Shetty } -------Petitioner
AND
Kiran Nayak }
& another } ----- Respondents

To
R2,
The United India Insurance Co.Ltd
Rep by its Present Branch Manager,
Branch Office, Putturu Branch
Prabhu Building, Opp.Aruna Talkies
Main Road, Puttur Village& Post
Puttur Tq, Dakshina Kannada Dt-574201

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
…………………………….. 2020.

(By order of the court)

Advocate for Petitioner Central Nazir

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IN THE COURT OF THE DISTRICT & SESSIONS

JUDGE AT UDUPI AND ADDL. M.A.C.T AT
KUNDAPURA
M. V. C. No. /2020
Between :
Rangayya Shetty } -------Petitioner
AND
Kiran Nayak }
& another } ----- Respondents

INDEX
Sl.No Description Pages C.F. Paid
1) Petition with verification Rs.10/-

2) Affidavith

3) Vakalathnama

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)

8) True Copy of the Petition

TOTAL

Rs.26/-

Place: Kundapura
Date: - -2020
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Advocate for the Petitioner