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Complete Home & Office Legal Guide
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Complete Home and Office Legal Guide (Chestnut) (1993).ISO
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1993-08-01
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48 lines
WHEREAS, on ____________________, ________________________, an
insurance company, was presented with a claim arising from:
__________________________
under insurance coverage provided to ______________, under its
coverage for:
___________________________________
and,
WHEREAS, on _________________________, ________________________
paid a claim in an amount of $ ________ ( ____________________ &
___/100 dollars), with a deductible of $_____(__________________
&___/100 dollars), arising from the perils and covered by the
policy stated above, NOW, THEREFORE:
______________, his heirs and assigns, herewith assign and convey
to ________________________ and any all rights against any entity
who may be liable to ______________ for the loss stated above.
______________ shall pursue any and all responsible parties at
its own expense, and may at its option, bring such action in its
own name or that of ______________.
______________ herewith covenants and agrees to fully assist
________________________ in pursuit of its rights of subrogation
herein.
________________________ may at its option pursue the deductible
loss of ______________. In the event that ____________________
does so, it shall notify ______________, and, further, _______
______ agrees that if any recovery is made that it will share in
all costs related thereto pro rata.
______________ further agrees not to release or exonerate the
adverse party or parties or enter into any compromise with them
without the prior approval of ______________________. _________
______ shall execute any and all instruments reasonably required
by ________________________ in connection herewith.
Date: _____________________________________
___________________________________________________