No. 29 Injuries Caused by Negligence on a Railroad.
A. B., the above-named plaintiff, states as follows :-
1. On the …… day of…… 19… , the defendants were common carriers of passengers by railway between …… and……
2. On that day the plaintiff was a passenger in one of the carriages of the defendants on the said railway.
3. While he was such passenger, at…… [or near the station of…… or… .. between the stations of… ..and… .], a collision occurred on the said railway caused by the negligence and unskilfulness of the defendants’ servants, whereby the plaintiff was much injured [having his leg broken, his head cut, etc., and state the special damage, if any, as], and incurred ex pense for medical attendance and is permanently disabled from carrying on his former business as [a salesman].
[As in paras 4 and 5 of Form No. 1, and Relief claimed.]