NOTICE TO A RAILWAY CLAIMING DAMAGES FOR LIABILITIES IN TORT OF A RAILWAY ADMINISTRATION
(CASE OF PHYSICAL INJURY)
Dated………..
Regd. with AID
To
The General Manager,                             Railway,
(Name the Railway with address)
Dear Sir
Subject: Notice under s. 106 of the Indian Railways Act 1989
Under instructions from my client (state here name, description and address) I hereby give you a notice claiming damages of Rs……..on account of personal injuries suffered by him as hereunder stated.
My said client was a qualified surgeon of good repute.
    My said client had on (date) purchased a 1st class ticket at...............Rly station on the……..Railway for a journey from......to.........by............(etc., name the train) and availed himself of a reserved seat in a 1st class compartment of the train. On…….. at about...............hours the train while driven carelessly and negligently by the workmen of the Railway met with a serious accident after it had collided with another train waiting in a station of the same Railway. In the result my client who was thrown off his seat lost both of his arms and became permanently disabled and unfit for carrying on his livelihood as a surgeon.
           My client is entitled to recover from the Railways a sum of Rs………as per account below.
           Please take notice that unless the said Railway pay to my client the said sum of Rs……….within 60 days from the date of receipt of this notice, my client shall file a claim petition before the Railways Claims Tribunal.
Particulars of claim
(a)Medical expenses incurred for treatment          Rs……….
(b)Physical and mental agony
caused by injury                                                     Rs	
(c) Loss of future earning as a surgeon
because of the loss of arms                                    Rs
                                                                Total       Rs.
                                                                                                                 Yours faithfully