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ACH Form

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Alicia Bruno
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0% found this document useful (0 votes)
11 views1 page

ACH Form

Uploaded by

Alicia Bruno
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
ca) UNITED FINAL RELEASE Claim No.: 1293704 Policy No.: 8A496009001PC IN CONSIDERATION of the payment of the sum of twenty four thousand seven hundred dollars and zero cents ($24,700.00), which includes all legal and assessor's costs and feos and the like in connection with the under-mentioned claim. I/WE, THE UNDERSIGNED, do hereby for myself/ourselves, my/or heirs, executors, administrators, successors and assigns release and forever discharge CG United Insurance TT Ltd. from any and all action, causes of action, claims and demands for upon or by reason of any damage, loss or injury to person and property which heretofore has been or hereafter may be sustained in consequence of or in ‘any way attributable to the incident which occurred in the vicinity of Eastern Main Road, Valencia on 2023-12-21. AND FOR THE SAID CONSIDERATION, I/WE further agree not to make claim or take proceedings against any other person or corporation who might claim contribution or indemnity under the provisions of any statute or otherwise. IT IS UNDERSTOOD AND AGREED that the said payment is not deemed to be an admission of liability con the part of CG United Insurance TT Ltd. AND it is hereby declared that the terms of the settlement are fully understood, that the amount stated herein is the sole consideration of the Release and that the said sum is accepted voluntarily for the purpose of making a full and final compromise adjustment and settlement of all claims for injuries, losses and damages resulting or to result from that said occurrence. Parts $15,000.00 Labour $8,500.00 Loss of Use (4 Days) $1,200.00 IN WITNESS WHEREOF I/WE have hereunto set my/our hand/hands this 2024-02-06 In the presence of. (Witness) [Please read before signing below.) signature Ni 10. no. 147207123003 Nigel Bruno 66 United insurance TT Ltd. Princes Court, 2nd Floor. 15-17 Keate Street, Port of Spain, Tinlad & Tobago A member of Covalisle Group Ltd INSURANCE © a SSS SEO

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