Form - Application under section 42A/53N(1)/53Q(2) of the Competition Act, 2002 - Competition Appellate Tribunal (Procedure For Appeals And Applications) Regulations, 2010

FORM Before the Competition Appellate Tribunal, New Delhi Application....................of 20 (Name and address of the applicant) Applicant Versus (Name and address of the respondent) Respondent Application under section 42A/53N(1)/53Q(2) of the Competition Act, 2002 Sir, The Applicant begs to submit as under 1. Brief facts of the claims. 2. Brief narration of the anti-competitive agreements or/and abuse of dominant position. 3. Details of the orders passed by the Commission. 4. Brief narration of the contravention, if any, of the orders of the Commission. 5. Particulars of loss, damage or injury and the amount payable. 6. Particulars of proceedings, if any, under 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 ..... 20.............. . The contents of above paras..... are true to the best of my knowledge and nothing has been concealed therefrom. Signature of the applicant. Encl. 1. Attested affidavit. AFFIDAVIT I.......... S/o.......... aged.......... years, resident of.......... swear in the name of God/solemnly affirm and state as under: (1) I have gone through my application for grant of compensation under section 42A/53N(1)/53Q(2) of the Competition Act, 2002. The same is correct. The annexures are true copies to their originals/and true translation of the originals. (2) The aforesaid is the only application made. The particulars of the application/applications in addition to the aforesaid application are as under. (3) No such application was filed either by me or on my behalf under any other Act, 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 as under AFFIDAVIT I.......... S/o.......... aged.......... years, resident of.......... swear in the name of God/solemnly affirm and state as under: (1) I have gone through my application for grant of compensation under section 42A/53N(1)/53Q(2) of the Competition Act, 2002. The same is correct. The annexures are true copies to their originals/and true translation of the originals. (2) The aforesaid is the only application made. The particulars of the application/applications in addition to the aforesaid application are as under. (3) No such application was filed either by me or on my behalf under any other Act, 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 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 Competition Appellate Tribunal. Deponent VERIFICATION I solemnly, affirm/swear in the name of God that whatever is stated in Paras 1 to 5 above are true to my knowledge and no material fact is concealed by me. Place.......... Date.......... Deponent Notes : (1) The affidavit shall be attested by an Oath Commissioner or a Civil Judge or a Sub-Judge First Class or a Magistrate or a Notary Public and need not be on a Non-Judicial paper. (2) Strike out whichever is not applicable.