General Form

Registered A.D./U.P.C.

Dated …………………….
Shri ………………………..
Address:…………………..
Phone: ………………………..

To

Shri ……………………….
S/o  ……………………….
R/o  ……………………….
Notice of Accident & Compensation

Sir,

I have to serve you with the notice or behalf of my client Shri ………………………….. S/o…………………………… R/o……………………… aged ……………… as follows :

1. That you are the owner of vehicle…………………….. Model……………… Regd. No……………..

2. That you knocked down the vehicle of my client …………………  model …………….Regd. No. …………………….. on …………. date …………………… at ……………….. for which he lodged FIR at ……………….. police station numbering ……………

3. That my client has sustained loss of Rs. ………………….. for the reasons and account as follows :

(a) …………………….
(b) …………………….
(c) …………………….

I, therefore, hereby call upon you to pay my client the said amount within ……………. days from the date of receipt of this notice, otherwise we shall follow up the matter with MACT.

Sd/-
Advocate
Insurer											
Address