CONSENT LETTER FOR SPOT SETTLEMENT

[To be obtained on Rs.100/- Stamp Paper – TO BE NOTARISED]

Date: 09-09-2022

To
The Manager
Digit General Insurance Co. Ltd
Atlantis, 95,4th B Cross Road,
Koramangala Industrial Layout,
5th Block,
Bangalore 560095

I, SINGH CONSTRUCTION CO had obtained a comprehensive insurance policy from

Go Digit General Insurance Ltd. under Policy No- D037921663 & Claim no-202200200474
respect of my vehicle Regn.No. JH01CC0671, Engine No. 63535519 & Chassis No.
3F17627 having policy period from 23-09-2021 to 22-09-2022.During the existence of
the above-mentioned policy, the said vehicle met with an accident and my vehicle
sustained loss on 06-06-2022.

After the mutual discussion and negotiation, I have voluntarily accepted settlement on
Spot Settlement Basis.

The spot settlement amount arrived at after a mutual negotiation is acceptable to me,
and I undertake not to raise any issue or dispute regarding the same. I am repairing the
vehicle on my own and I have agreed to accept the sum of Rs.81,000/- only (Eighty One
Thousand Rupees only) which has been calculated after policy excess of Rs.1500/- as a
mutually negotiated settlement on spot settlement basis. I undertake that I will never
raise an issue or litigate on this mode of mutually negotiated spot settlement on Non-
Standard basis. I utilize this amount to repair insured vehicle and I submit the repair and
re inspection photos once done. My Insurers are not at all liable for any Expenses.

This consent letter has been voluntarily given and I am aware that the same is a
condition precedent for the mutually agreed mode of settlement.

I further state on oath that I have filed a claim application for compensation before the
Insurance Company. I further state on oath and undertake that if any irregularity/
breach of policy is disclosed on receipt of the investigation report, then the insurance
company shall be entitled to recover the entire compensation amount given to me by
the insurance company along with the interest thereon as deemed fit. I shall not have
any right to raise any objection in respect thereof. As confirmed by that there are no
injuries to third party or driver or helper at the time of accident of the vehicle if any
dispute arises in future, I will take care and I will not raise any claim.

Date:

(Name & Signature of Insured)

(Name & Signature of Witness)

Enclosures: Aadhar Card & Pan Card