I hereby declare that the information given above is correct.

Signature of the applicant.

Place : ..........

Date : .........

Form COMP. PENAL

[See rule 349 of the West Bengal Motor Vehicles Rules, 1989]

Government of West Bengal

Office of the District Magistrate/ Sub-divisional Officer Motor Vehicles Department

To

Whereas the vehicle No. .. .. .. ..owned by.. .. .. .. .. .. ..driven by.. .. .. ..was found plying on.. .. at. .. ..in violation of the provisions of section/s .. ..of the Motor Vehicles Act, 1988 and whereas you.. .. .. .. .. .. .. .. .. ..driver/owner of the vehicle at the time of detection of the offence have prayed to be excused and opted for compounding of the offence under sub-section (1) of section 200 of the Motor Vehicles Act, 1988, and whereas the maximum penalty imposable for the offence/s committed under section/s .. .. .. .. .. .. .. ..of the Motor Vehicles Act, 1988 In total is Rs. .. .. .. .. .. ..(Rupees .. .. .. .. .. .. .. ..);

Now, therefore, in exercise of the powers conferred upon me under sub-section (1) of section 200 of the Motor Vehicles Act, 1988, I do hereby compound the offence/s under section 200 of the Motor Vehicles Act, 1988. on payment of Rs ..(Rupees.. ..) only by you and direct you to deposit the amount to the Motor Vehicles Department,.. (failing which prosecution will be started in the appropriate Court of Law).

The seized documents as per seizure list will be returned to you on production of the receipt before the Motor Vehicles Department, showing deposit of compounded amount before the officer who remains in charge of the Motor Vehicles Department.

Full Signature of the Compounding

Officer with designation.

I committed the offence/s as mentioned in paragraph I.

I am agreeable to compound the offence/s and to pay Rs.. .. .. .. .. .. .. .. (Rupees.. .. .. ..) as directed.

I (Name and address).. .. .. .. .. .. .. .. .. .. .. .. hereby do declare that I was driving the above vehicle and received a Checking Report.

I do hereby bind myself to either compound the offences enumerated in Checking report mentioned above within 7 days from this date or to remain present on........ before the Court to decide the case.

I hereby declare that I shall inform the registered owner about checking report mentioned above.

Date...........

Place.........

Signature of the driver/owner of the vehicle.

* To be scored out where the prosecution has already been instituted

Form COMP. A

[See rule 329 of the West Bengal Motor Vehicles Rules, 1989]

An Application for Compensation

To

The Motor Accidents Claims Tribunal

.. .. .. .. .. .. .. .. ... .. .. ..

I, .. .. .. .. .. .., son/daughter/wife/widow of.. .. .. .., residing at.. .. ..having been injured in motor vehicle accident, hereby apply for the grant of compensation for the injury sustained. Necessary particulars in respect of the injury, vehicle, etc. are given below :

I.. .. .. .. ..son/daughter/wife/widow of.. .. .. .. .. .. residing at.. ..hereby apply. as a legal representative/agent, for the grant of compensation on account of death/injury sustained by Shri/Kumari/Shrimati.. .. son/daughter/wife/ widow of .. ..Shri/Shrimati.. ..who died/ was injured in a motor vehicle accident.

Necessary particulars in respect of the deceased/injured, the vehicle, etc. are given below :