FORM
Before the Monopolies and Restrictive Trade Practices Commission, New Delhi
Compensation Application No..... of 19 .....
(…………………………)
(Name and address of the applicant:
Applicant;
Versus
(Name and address of the respondent): Respondent.
Compensation Application under Section 12B of Monopolies and Restrictive Trade Practices Act, 1969
Sir,
The applicant begs to submit as under : —
1. Brief facts of the claims.
2. Brief narration of monopolistic, restrictive or unfair trade practice.
3. Particulars of loss, damage or injury and the amount payable.
4. Particulars of proceedings, if any, under the Consumer Protection Act or any other law in respect of the same matter.
Prayer
(State exact amount, rate of interest or any amount on any other account).
Signature of the applicant
Verification
Verified at ...... on the ..... day of ...... 19 .... The contents of above paras are true to
the best of my knowledge and nothing has been cancelled therefrom.
Signature of applicant
Ends: 1. Attested Affidavit.
2. Attested photocopy of deposit receipt (if applicable)
Affidavit
I ........ s/o ......... aged ........ years, resident of ......... swear in the name of God/sol-
emnly affirm and state as under:
(1) I have gone through my application for grant of compensation under Section 12B of the MRTP Act, 1969. The same is correct. The annexures are copies true to their originals /and true translation of the originals.
(2) The aforesaid is the only application/I made such an application to the Director General of Investigation and Registration /Secretary /Chairman, M.R.T.P. Commission in addition to the aforesaid application. The particulars of the application/applications sent by me are as under:
(3) No such application was filed either by me or on my behalf under the Consumer Protection Act, 1986 in respect of the same matter.
(4) I did not receive any amount in respect of the aforesaid compensation from any one whether through any Court or otherwise.
OR
I received a sum of Rs... out of the compensation claim particulars of which are as under:—
(5) I undertake that if I receive any amount from any source in connection with or relating to the aforesaid compensation, I will intimate the same to the M.R.T.P. Commission
DEPONENT
Verification
I solemnly affir/swear in the name of God that whatever is stated in paras 1 to 5 above is true to my knowledge and no material fact is concealed by me.
Place:
DEPONENT
Date:
Note:
(1) The affidavit shall be attested by an Oath Commissioner or a Civil Judge or a Sub-Judge 1st Class or a Magistrate or a Notary Public and need not be on a Non-Judicial paper.
(2) Strike out whichever is not applicable.?
