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Gemconnt Unguerry lac i Mmdslan Sul Date of Issue pol soi 1.Mel Mi Mie Bre SFU M1 ODO NMG Loree or 1% O8Chord _ tee o2 Donato ake Dubla ae aay Dateof Birth 2¢ [2 | 175 agres te accept from Liberty Insurance the sum speifed below in cca ccen at nig sada ncsinr wn 1271S een es ee ee ed a riedarena nc MUG. Une 11S Donne Personal losses: Property losses: Total: €Bam- 2 Date Cheque to be Issued + (Uiless further communieation is received in writing from the abpve named ‘Tots! Amount in Wards:_£ Fatal i. 1 accept this amount without adm Insurance have advised me that I ia Signed: Witnessed: Print Name: ChLiain€ Ge or { acknowledge that I have been given ten (18) husiness days in which to reconsider my acceptance of this offer but Lam waiving my right to this cooling off period ‘Signed: Finn Me Dem Es ae 2/67 PAYMENT AUTHORISATION Please issue cheque as per above agreement Claim Rep BV DOSEN 1/521 Mele. S_ eamerbanry Signed: Ci m Qo Date: a» |e i> at Froteson Sntement “Toe nimaton yn pei wil remain conde a wl be wed io rscor and cross fee the paren of your Gambtacy auch as saree rk fa ROL and UECACHTE ie MUU) sac foie pevertion of aud may Be nscesay us euhange sour {norman nth realtor al wocang bodies, service rows or pets vesemr: appa by ws, agets and eahesmsirmnce coma. We ks ‘Zooteed 1 callootand dslee seme a Goch 4 adel conibon and canal convictions) reaing to you with is ean pas which re Tised shove. We wil esque your tent in tera else such aeration sith msutsne inducry

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