Section 12 in The Public Liability Insurance Rules, 1991
12. Any other information that may be considered necessary or helpful in the disposal of the claim:
I hereby swear and affirm that all the facts noted above are true to the best of my knowledge and belief.Signature of the Claimant[FORM II [Inserted by G.S.R. 596(E), dated 20-9-1991 (w.e.f. 20-9-1991)]Form Of Notice[See Rule 9(1)]By Registered Post acknowledgment dueFrom*...............................................................................................................................................................To...............................................................................................................................................................Notice under clause (b)of section 18 of the Public Liability Insurance Act, 1991;Whereas it appears to me/us that an offence under the Public Liability Insurance Act, 1991(6 of 1991) has been committed/is being committed by................................................................................................................................................I/We hereby give notice of sixty days under clause (b) of section 18 of the Public Liability Insurance Act, 1991 of my/our intention to file a complaint in the court against........................................................................................................................................................................................................................for violation of section ....................................................... of the Public Liability Insurance Act, 1991.I/We, in support of this notice, hereby enclose the following documents as evidence of proof of violation of the Public Liability Insurance Act, 1991:................................................................................................................................................Place......................................................Date.....................................................Signature(s)* In case the notice is given in the name of a Company, documentary evidence authorising the person to sign the notice shall be enclosed to this notice.** Here give the name and address of the alleged offender. In case of a handling/manufacturing/processing/operating unit indicate the name of the unit/location and nature of activity.*** Documentary evidence includes photographs/technical reports/health reports of the area, etc., relating to the alleged violation/offence.]Appendix IMinistry of Environment and Forests(Department of Environment, Forests and Wildlife).Notification
