| Whether Medical Examination has been done *: |
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| Whether Final report/charged sheet is filed *: |
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| Name of Court where case is pending *: |
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| Status of case, if pending Next date of hearing *: |
|
| Date of Next Hearing : |
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Date of Judgement, if Disposed : |
|
| Details of Compensation received from court/other scheme *: |
|
| Annual Income of Victim *: |
|
Annual Income of family *: |
|
| Expenditure on treatment,if any *: |
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Other Expenditure *: |
|
| Details of Financial Losses Suffered *: |
|
