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- #3600
- @001 Enter the name of the insurance company:
- @002 Enter the name of the insured:
- @360/@360/@360/@360 Enter nature of peril resulting in claim:
- Automobile collision
- Fire
- Theft
- KEY IN VALUE
- @361/@361/@361 Enter the type of coverage claim was paid under:
- Automobile Collision/Comprehensive
- Homeowner's
- KEY IN VALUE
- !362 Enter the amount of the claim in numerals:
- !363 Enter the amount of the insured's deductible in numerals:
- #3601/#3602 The insured's deductible:
- Will be collected by the insuror
- Will be retained by the insured
- #3603
- #end control section
- #3600
- /* para. 3600: Insurance Subrogation agreement */
-
- SUBROGATION AGREEMENT
-
-
- WHEREAS, on ____________________, @001, an insurance company,
- was presented with a claim arising from:
-
- @360
-
-
- under insurance coverage provided to @002, under its coverage
- for:
-
- @361,
-
-
- and,
-
- WHEREAS, on _________________________, @001 paid a claim in an
- amount of $ @362 (!362 dollars), with a deductible of $ @363
- (!363 dollars), arising from the perils and covered by the policy
- stated above, NOW, THEREFORE:
-
-
- @002, his heirs and assigns, herewith assign and convey to
- @001 and any all rights against any entity who may be liable
- to @002 for the loss stated above.
-
-
- @002 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 @002.
-
-
- @002 herewith covenants and agrees to fully assist @001 in
- pursuit of its rights of subrogation herein.
- #3601
- /* Para. 3601: Deductible */
-
- @001 may at its option pursue the deductible loss of @002.
- In the event that @001 does so, it shall notify @002, and,
- further, @002 agrees that if any recovery is made that it
- will share in all costs related thereto pro rata.
- #3602
- /* Para. 3602: Deductible by insured */
-
- The insured shall retain separately its rights to recover
- the deductible loss.
- #3603
-
- /* Para. 3603: Closer */
-
- @002 further agrees not to release or exonerate the adverse
- party or parties or enter into any compromise with them
- without the prior approval of @001. @002 shall execute any
- and all instruments reasonably required by @001 in connection
- herewith.
-
-
- Date: _____________________________________
-
-
-
-
-
- ___________________________________________________
-
- @002
-