Form I
Rule 5 of the Railway Claims Tribunal (Procedure) Rules 1989 and section 16 of the Railway Claims Tribunal Act 1987
Title of the Case : AB …………………… Claimant
And
General Manager …… Railways
Respondent
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
AB, residing at …………………… Applicant
And
General Manager ……… Railways Respondent
1. Particulars of the applicant
Name: AB
Address:
2. Particulars of the respondent: General Manager ………………
3. Value of claim and details of application fee:
(a) Value of claim: Rs. 5,00,000
(b) Details of application fee: ……………….
4. (i) Name and address of the Bank on which the draft is drawn: X Bank Ltd.
(ii) Demand Draft No. ……….. for Rs. ……….. payable at Calcutta Branch
5. Full booking particulars of the consignment:
(a) Date of booking
(b) R/R or parcel way bill
(c) Station from ……….. to ……………..
(d) description of consignment
(e) value of consignment
(f) any other particulars
6. Date on which notice served on Railway Administration under section 106 of the Railways Act 1989 (copy to be attached)
7. (i) Facts of the case
(ii) (a) nature of the relief sought
(b) grounds of relief
8. Matters not previously filed or pending with any other court.
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 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.
Signature of the applicant
Full address
Date:
Place:
To
The Registrar
Railway Claims Tribunal
…….…….. Road, Calcutta