Sub: Application to Refer Pending MAC Appeal No. Title As to Lok Adalat
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To,
The Secretary DHCLSC, New Delhi.
Sub: Application to refer pending MAC Appeal No. ………………... title as ...... to Lok Adalat.
Sir,
The claimant/ insurance company in the abovementioned matters wants to settle the case in Lok Adalat. As per Claimant/Insurance Company the grounds of enhancement/reduction of compensation are on following heads:
Grounds of enhancement of compensation Approximate Amount Sr. No.
1. Multiplier
2. Pecuniary/non-pecuniary damages
Loss of working capacity in relation to 3. disability
4. Any other head
TOTAL
Pending connected Appeal/ case, if any......
DECLARATION
Applicant/ claimant further declare that the above said particulars are true and correct to the best of his knowledge.
Date: ……………….. (Signature of Claimant/Insurance Co./Counsel)