Scribd Logo
Upload

Welcome to Scribd!

  • Release of Claim With Subrogation Right

    Uploaded by

    Asero Bautista
    133 views2 pages
    This document is a Release of Claim with Subrogation Rights between an individual and Fortune General Insurance Corporation. It releases Fortune General Insurance from all claims and liabilities arising from an accident that occurred on a specific date in exchange for a monetary payment. It also assigns subrogation rights to Fortune General Insurance, allowing them to pursue legal action against other liable parties. The individual acknowledges reading and understanding the agreement, which is signed before a notary public.

    Original Description:

    Original Title

    RELEASE OF CLAIM WITH SUBROGATION RIGHT

    Copyright

    © © All Rights Reserved

    Available Formats

    DOC, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    This document is a Release of Claim with Subrogation Rights between an individual and Fortune General Insurance Corporation. It releases Fortune General Insurance from all claims and liabilities arising from an accident that occurred on a specific date in exchange for a monetary payment. It also assigns subrogation rights to Fortune General Insurance, allowing them to pursue legal action against other liable parties. The individual acknowledges reading and understanding the agreement, which is signed before a notary public.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    133 views2 pages

    Release of Claim With Subrogation Right

    Uploaded by

    Asero Bautista
    This document is a Release of Claim with Subrogation Rights between an individual and Fortune General Insurance Corporation. It releases Fortune General Insurance from all claims and liabilities arising from an accident that occurred on a specific date in exchange for a monetary payment. It also assigns subrogation rights to Fortune General Insurance, allowing them to pursue legal action against other liable parties. The individual acknowledges reading and understanding the agreement, which is signed before a notary public.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 2

    RELEASE OF CLAIM WITH SUBROGATION RIGHTS

    KNOW ALL MEN BY THESE PRESENT:

    FOR AND IN CONSIDERATION OF THE SUM


    PESOS___________________________________________________ (P__________)
    Philippine Currency, receipt of which is hereby acknowledge and confirmed, I,
    __________________ , of legal age, Filipino, married/single and with residence and postal
    address at _____________________________________ do hereby forever RELEASE,
    DISCHARGE AND ACQUIT FORTUNE GENERAL INSURANCE CORPORATION, its
    successors and assignees, free from all actions, demands and rights of action that now exist or
    may thereafter develop of all known, unknown and unanticipated injuries, damages and/or losses
    arising out of and as a consequence of an accident/loss which occurred on or about
    ___________________ at _______________________________ .

    I declare that this payment is voluntarily accepted as a full and final compromise,
    adjustment and settlement of all claims and that payment of said amount shall never be construed
    as an admission of liability.

    I further agree that FORTUNE GENERAL INSURANCE CORPORATION be


    subrogated with all my rights of recovery of all claims, demands and rights of action on account
    of loss, damage or injury as a consequence of the accident/loss above mentioned against any
    person, corporation or whoever may be liable thereafter and I/We shall assist and authorize
    FORTUNE GENERAL INSURANCE CORPORATION to institute legal action/s, prosecute,
    compromise, settle and withdraw in my name all proceedings which may be deemed necessary to
    effectively enforce my claim.

    I hereby manifest that I have thoroughly read and understand the terms of this Release of
    Claim with Subrogation Rights.

    IN WITNESS HEREOF, I have hereunto set my hand this ______ day of


    _________________ at _________________ .

    __________________________________
    Insured’s signature over printed name

    SIGNED IN THE PRESENCE OF:


    ___________________________ _____________________________
    Witness Witness

    BEFORE ME, a notary public, this _____ day of ___________ , personally appeared
    _______________ with community tax certificate no. _______________ issued at
    _______________________________ on _______________ known to me and to me known to
    be the same person who executed the foregoing Release of Claim with Subrogation Rights and
    he/she acknowledged to me that the same is his/her own free and voluntary act and deed. I further
    certify that the contents of the foregoing instrument were fully read and explained to the above
    name person to his/her full satisfaction.

    WITNESS MY HAND AND SEAL on the day, year and place written above.

    You might also like