t*******s
发帖数: 1016 | 1 前两天看到版上有人问，我就发一个我的保险公司曾经给我的的文本把。这里为什么不
能贴PDF？那就txt将就看吧。
Discharge
I (victim/dischargor's name and address,possibly d.o.b.) ACKNOWLEDGE that I
have agreed to accept from the Dischargees named in the Schedule hereto the
sum of $100.00 in full satisfaction and discharge of all actions suits
claims and demands whatsoever brought by me against the Dischargees and/or
their heirs executors administrators and successors in title arising
directly or indirectly out of an accident which occurred on the date and
place specified in the Schedules hereto and in which I suffered bodily
injury and other loss and damage.
AND I ACKNOWLEDGE that payment of the said sum is with a denial of liability
and to obviate the expense of litigation
AND I FURTHER ACKNOWLEDGE that this Discharge may be placed in bar to any
such action suit claim of demand
AND I FURTHER ACKNOWLEDGE that the said sum is inclusive of those special
damages in the sum of $0.00 already paid by the Dischargees
AND I FURTHER ACKNOWLEDGE that the said sum is subject to the payment of any
charge pursuant to the provisions of the Social Security Act or the Workers
' Compensation Acts or the WorkCover Act or the Health and Other Services (
Compensation) Act, or the Health and Other Services (Compensation) Care
Charges
Act or any other Statute
AND I HEREBY AGREE to indemnify the Dischargees against any claims which may
hereinafter be made against them is respect of any such charge
AND I FURTHER AGREE to indemnify the Dischargees against any claims which
may hereinafter be made against them in respect of the payment to me
hereunder
AND I DIRECT that payment be made to myself whose receipt for such payment
shall be a sufficient discharge.
THE SCHEDULE
1. Dischargor(s) Victim name
2. Dischargee(s) at fault driver or the insurance company
3. Date of Accident date
4. Location of Accident: location
Dated at 30th day of September of 2010
Witness: signature
Discharger: signature | M***s
发帖数: 8769 | | t*******s
发帖数: 1016 | 3 我要问斑竹要包子
【在 M***s 的大作中提到】
: 支持！！
| c********g
发帖数: 174 | 4 从网上收集了资料，稍作修改，请指正。
尤其，请问：
受害方车上其他乘客如果需要补偿，应该找自己的司机的保险公司还是直接找肇事方保
险公司？
如果受害方司机签了这个release form之后，受害方车上其他乘客或者受害方保险公司
（当受害方车上乘客向受害方司机保险公司索偿时）还能向肇事方或其保险公司索偿吗？
谢谢。
GENERAL RELEASE—AUTO ACCIDENT OF _______________
Party A: __________________ ID: __________________
Party B: __________________ ID: __________________
Party A and Party B were in an automobile accident in ______________________
____ on ________________(date). As a result of the accident, PartyB
suffered damage to his/her vehicle, and may have suffered personal injuries
to people on his/her vehicle.
Without admitting fault, the parties wish to settle and compromise all
claims arising from this incident forever. PartyA hereby pays to PartyB the
sum of _______________________, receipt whereof PartyB hereby acknowledges,
and PartyB further states that said sum constitutes complete compensation
for all claims arising from said incident, whether known or unknown, and to
include both property damage and any personal injuries that might have been
suffered in said incident.
This General Release and payment made hereunder are intended to bring
closure to this matter and any further claims shall be forever barred.
________________________ _________________________
Dated _______________ Witness_________________________
I
the
【在 t*******s 的大作中提到】
: 前两天看到版上有人问，我就发一个我的保险公司曾经给我的的文本把。这里为什么不
: 能贴PDF？那就txt将就看吧。
: Discharge
: I (victim/dischargor's name and address,possibly d.o.b.) ACKNOWLEDGE that I
: have agreed to accept from the Dischargees named in the Schedule hereto the
: sum of $100.00 in full satisfaction and discharge of all actions suits
: claims and demands whatsoever brought by me against the Dischargees and/or
: their heirs executors administrators and successors in title arising
: directly or indirectly out of an accident which occurred on the date and
: place specified in the Schedules hereto and in which I suffered bodily
| k*****o
发帖数: 1972 | | k*****o
发帖数: 1972 | | s******y
发帖数: 18 | | M*****c
发帖数: 2753 | 8 支持！！
I
the
【在 t*******s 的大作中提到】
: 前两天看到版上有人问，我就发一个我的保险公司曾经给我的的文本把。这里为什么不
: 能贴PDF？那就txt将就看吧。
: Discharge
: I (victim/dischargor's name and address,possibly d.o.b.) ACKNOWLEDGE that I
: have agreed to accept from the Dischargees named in the Schedule hereto the
: sum of $100.00 in full satisfaction and discharge of all actions suits
: claims and demands whatsoever brought by me against the Dischargees and/or
: their heirs executors administrators and successors in title arising
: directly or indirectly out of an accident which occurred on the date and
: place specified in the Schedules hereto and in which I suffered bodily
| c**t
发帖数: 33 | | T*****g
发帖数: 424 | | s********s
发帖数: 388 | |
|
