ELAIYAKUMAR
1

[ To be obtained Rs 100/-Stamp paper- TO BE NOTARISED]
LETTER OF SUBROGATION.
CLAIM NO
Policy No;
Incident Date
Insured
1. In consideration of you paying into us the sum of Rs._____/-(Rupees only) In pursuance of the said policy in respect of loss due to theft. We the owners hereby empower and authorized you to prosecute legally all our actionable claim. Rights and remedies both in equity and at law against the administration, other public bodies. Persons whosoever is liable in respect thereof and/or for whom or other financial assistance, etc. in respect of such loss of damage.
2. We hereby subrogate to you all rights remedies that we have. Is consequence of or arising from theft to the said properties and we further grant to you full power to take and use all lawful ways and means a recover the said goods/any part thereof and or loss from whom it may concern.
3.we also hereby authorize you to use our name in any action or proceedings that you may bring either in your own name or in relations to any to any of the matters hereby authorized to you and we undertake for ourselves to assist and concur in any matters or proceedings which you may deem expedient or necessary in any such actions or proceedings and to execute all deeds and/or documents including any and all pleadings and reasons which. May be necessary therefore and generally to assist therein by all means in our power.
4 we hereby appoint you. Your officers and agents and theirs successors severally our agents and attorneys in fact with irrevocable power to collect all such claims and to begin prosecute compromise arbitrate or withdraw either in our name or in your name but at you expense if any and all legal proceedings which may deem necessary to enforce such claim or claims including proceedings before any tribunal/forum and to execute in our name only documents which may be necessary to carry into effect the purpose of this agreement.
5 We further undertake if called upon by to do so ourselves to institute any such action or proceedings that may direct on your behalf it being understood that you are to indemnify us and any other persons whose names may necessarily be used against any costs changes or expenses which may be incurred in respect of any action or proceedings that may be taken virtue of this agreement.
6.The payment receipted for herein is accepted with the undertaking that the said payment shall not ensure to the benefit of any fort, lessor or misfeasemont under the writer does not waive any rights or remedies which or subrogation or otherwise against any fort lessor or misfeasemont and acceptance of this receipt shall not prejudice or take any right or remedies which the said underwriter would otherwise have any virtue of such payments.
7. We further agree that any money collected from any government, state or authorizes or any persons shall be your property and if received in the first instance by the undersigned. We undertake to make over to you immediately the amount so recovered.
8. We hereby further agree that in the events of the lost goods subsequently being traced we undertake to accept and take delivery of the same and the claim shall then be re adjusted on the correct basis of the then loss and in the event of any refund providing to be due to the underwriter on demand to make such refund you.
TO WINTNESS WE HAVE SET OUR HAND THIS ¬¬¬¬______DAY OF _____200..,
Signature.________ _______
Witness:
Name______________
Address:_____________
Declaration
Mr. /Mrs. / M/s.______________________, S/o,__________________ registered a theft claim against policy no. ___________________ and the Clime No. is _________________, For the theft of may vehicle hearing Registration no. ______________ Model ______________
In this regard, I have revived Rs._____________ towards my theft Claim payment from Reliance General Insurance Company as full land Final settlement and I have agreed for the same
As on today the vehicle is not traceable/ recovered. Future if vehicle gets traced/ recovered I shall extend my support and fullest cooperation to Reliance General Insurance Company Limited to get the possession of the same from Police/Courts in its favor with my own costs.
The above Declaration is given with a free will, without undue influence or coercion.
(Signature of the insured)
Date:
[Place:

From India, Chennai
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