(Translated from Portuguese)

To the
Honorable Judge of the
Judicial Court of the County of [country]

Legal Proceedings

[country]

[name], married, resident in [country] at [addreess], is hereby bringing

DECLARATIVE PROCEEDINGS IN FORM OF AN ORDINARY LAW SUIT
against,
"....", an insurance company with Register Office in [country] at [address] in the following terms and upon the following grounds:

First
On October ...., by 7:50 a.m.,

Second
... was driving the motorcycle bearing the license plate ....., down .... street, coming from ...road towards ... Street,

Third
At a velocity of about 20 km per hour,

Fourth
Immediately after the crossing of ...street with ....Road, the rear of its motorcycle was all of sudden violently hit by the front of the vehicle bearing the license plate ..., driven by .....

Fifth
With the force of the impact the motorcycle was thrown towards the right side of the road, hitting the rear of another vehicle bearing the license plate ..., which was parked along the sidewalk.

Sixth
The referred ...., was driving the car bearing the license plate ... at a speed of no less than 70 km per hour, completely alienated to the rest of the traffic.

Seventh
In fact, as later proved by the alcoholometry check performed after the accident, ... showed a 2.047 g/l ratio of alcohol in the blood, while the driver of the motorcycle had not drunk any alcoholic beverage.

Eighth
The circumstances surrounding the said road accident were object of a judgement delivered in the proceedings no.: ...., a certificate thereof is attached hereto as document no.: 1.

Ninth
The civil liability of the vehicle bearing the license plate ... has been transferred upon the hereby Defendant by reason of Policy no.: xxxx

Tenth
The facts hereinbefore described are found to be in contravention of Article 68, no.: 1, 22 and 23, subparagraph a), all in the Law-decree 16/93/M, of April 28th, and oblige the Defendant, under the insurance agreement, to compensate the Plaintiff for damages to property and pain and suffering, as detailed hereunder.

Eleventh
After the collision, the driver of the motorcycle, the hereby Plaintiff, was immediately carried to the "..." Hospital where he was admitted for treatment ...3rd, ...; from March ..., .... to April .., ... and from January ., ... to January 31st, ...

Twelfth
He suffered several "bruises on the right elbow and front part of the forearm, aggravated swelling of middle third on left leg with pain upon compression, at the point of fracture there is a 1cm2 surface wound (…), the x-ray shows a fracture to the middle third and lower third of the left tibia and fibula bones".

Thirteenth
The Plaintiff was operated twice to the left leg for "reduction, external fastening with steel line, and external fastening of the medium third of left leg" (doc. 2).

Fourteenth
All these treatments were a direct consequence of the described accident and forced the Plaintiff to 530 days total permanent disability, as evidenced by the medical reports attached hereto as documents no.: 3, 4. 5 and 6.

Fifteenth
In hospital costs the Plaintiff spent the amount of $..,000.00, corresponding $..,.....00 to expenses incurred at the .. ... Hospital; $....00 to expenses incurred at the .. ... Hospital and $..,....00 to expenses incurred with traditional Chinese medicine, all according to documents nos.: 7 to 92.

Sixteenth
The Plaintiff is a workman and earned the amount of $360.00, daily, at the time of the accident.

Seventeenth
As hereinbefore mentioned, by doctor's recommendation, the Plaintiff was unable to work for 530 days, which corresponds to a loss in earnings of MOP$...,800.00 (MOP$....00x530 days).

Eighteenth
Besides, due to the seriousness of his health condition and disability, his wife, ... .. ..., had to remain home to help him for one month, thus losing her income for the amount of $...,000.00.

Nineteenth
In transportation costs, the Plaintiff spent the amount of $1,000.00, taking taxis from his house to the Hospital and back.

Twentieth
With the repair of his motorcycle the Plaintiff spent MOP$..,....00.

Twenty-first
Last, but by no means least in importance, the Plaintiff felt and still feels pains from the wounds that resulted from the accident, plus worries about his health condition.

Twenty-second
It is not uncommon for the Plaintiff to wake up in the night soaked with sweat from nightmares related to the accident.

Twenty-third
All this pain and suffering is bound to be compensated, whereof the Plaintiff claims damages for pain and suffering for an amount no less than $...,000.00.

Twenty-fourth
According to the provisions of Article 477 and following, of the Civil Code, the Defendant, the ... Insurance Company, is the entity responsible for the payment of the compensation hereby claimed, which equals a total of $...,....00.

Twenty-fifth
The Plaintiff and the Defendant have legal entity, capacity and legitimacy.

LEGAL AID:
Twenty-sixth
The Plaintiff is poor and does not have the means to pay the costs with the present process.

Twenty-seventh
The Plaintiff does not have any property or yielding.

Twenty-eighth
In fact, to this day, he is still unemployed.

Twenty-ninth
His wife earns only $..,000.00 (doc. No.: 93).

Thirtieth
Thus, according to the provisions of Article 83 of the Traffic Regulation, the Plaintiff holds the presumption of economic insufficiency and is eligible to receive legal aid benefits, in the form of full waiving of prepayment costs and court fees to be granted.
In these and other terms applicable by Law, with your Honor's addition, the present proceedings must be judged well founded, proved and consequently the Defendant must be sentenced to pay to the Plaintiff the amount of $...,....00 (.. .. and ..-.. thousand two hundred and fifty [currency]), plus accrued interest at legal rate counted from the date of summons until full and effective payment.
The Plaintiff must be granted the legal aid in the form hereinbefore petitioned.
Thus, we hereby request that Your Honor may order the Defendant to be served default summons in the terms and threatening prescribed by Law.
The Plaintiff considers proved the matters presented under Articles first to eighth of the present proceedings and is prepared to prove all remaining facts.
The Plaintiff requests that the Insurance Company be notified to submit the Policy that entitles the insurance agreement referred to under Article ninth hereof.
Value of claim: $...,....00 (.. ... and ..-... thousand two hundred and fifty [currency])
Attachments: 93 documents, power of attorney and legalized duplicates.
The Lawyer, (sd.)

 

 

 

 

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