Application under section 16 of the Railway Claims Tribunal Act 1987

Form III

Application under section 16 of the Railway Claims Tribunal Act 1987 read with Rule 5 of the Railway Claims Tribunal (Procedure) Rules 1989 in respect of Caims for Refund of Fares or Part thereof or for Refund of any Freight  Paid in respect of Animals or Goods entrusted to a Railway Administration to be Carried by Railway

In the Railway Claims Tribunal

Before the ……………. Bench

AB ……….                      ………… Claimant

And

General Manager ……….. Railways

……… Respondent

Index

Description of documents attached      :

Signature of the applicant                    :

For use in Tribunal’s Office                  :

Date of Filing                                     :

Registration No.                                 :

Registrar                                           :                            Signature

In the Railway Claims Tribunal

Before the …………….. Bench

between

AB ……………                  Claimant

And

General Manager ……………… Railways

Respondent

1.   Particulars of the applicant:

Name:                                           AB

Address:

2.   Particulars of the respondent:

3.   Value of the claim and details of application fee.

(a)  value of claims: Rs. 5,00,000

(b)  details of application fee:

4.   Particulars of Bank Draft/Postal Order in respect of application fee:

(i)  name and address of the Bank on which the draft is drawn. X Bank Ltd., Calcutta Branch.

(ii)  demand draft No. ……………. payable at Calcutta Branch.

5.   Full particulars of payment of freight/fare:

(a)  Claim for refund of freight.

(i)  date of booking

(ii)  R/R/Parcel Way Bill

(iii)  Station from …………….. to ……………..

(iv)  description of consignment

(v)  freight paid

(vi)  amount of refund of claims

(vii)  Money Receipt/Credit Note or other payment particulars.

(b)  Claim for refund of fare:

(i)  Date of journey

(ii)  Train No.

(iii)  Class of travel

(iv)  Class actually travelled

(v)  ticket or ticket deposit receipt/excess fare ticket etc. guard’s or conductor’s certificate

(vi)  fare paid: Rs. ………………………

(vii)  refund claimed: Rs. …………………

6.   Date on which notice served on Railway administration under section 106 of the Railways Act 1989 in respect of claims for refund of freight (attach proof).

7.   (i)  Facts of the case.

(ii)  (a)  Nature of relief sought

(b)  grounds of relief.

8.   Matters not previously filed or pending with any other court (in case the applicant took any legal action give details and attach certified copy of the order).

9.   Jurisdiction of the Bench.

10.        List of enclosures.

Verification

I, ………………….. son of ………………… aged …………………. residing at ……………. do hereby verify that the contents of paragraphs ……………. to ………….. are true to my personal knowledge and those of paragraphs …………. to …………….. are believed to be true to the best of my knowledge or the legal advice given to me and that I have not suppressed any material fact.

Date:                                                                                         Signature of the applicant

Place:                                                                                       Full address:

To

The Registrar

Railway Claims Tribunal

……………. Bench

……………. Road

Calcutta