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Form #842From Liability under Uninsured Motorists Provision
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From Liability under Uninsured Motorists Provision - free to use
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Terms Of Use
Submissions to this site, including any legal or business forms, posts, responses
to questions or other communications by contributors are not intended as and should
not be construed as legal advice. You are strongly encouraged to consult competent
legal council before engaging in any action based upon content contained on this
site.
These downloadable forms are only for personal use. Retransmission, redistribution,
or any other commercial use is prohibited. This includes reposting forms from this
site to another site offering free legal or other document forms for download.
Please note that the donator may have included different usage terms regarding this
form, and you agree to abide by these terms. It is highly recommended that you have
a licensed attorney review any legal documents for which you are searching in order
to make sure that your needs are being properly and completely satisfied.
Your use of this site constitutes your acceptance of our terms of use and your
agreement to hold this site, its officers, employees and any contributors to this
site harmless for any damage you might incur from your use of any submissions contained
on this site. If you do not agree to the above terms, please do not proceed.
These forms are provided to assist business owners and others in understanding important
points to consider in different transactions. They are offered with the understanding
that no legal advice, accounting, or other professional service is being offered
by these documents or on this website. Laws vary in the different states. Agreements
acceptable in one state may not be enforced the same way under the laws of another
state. Also, agreements should relate specifically to the particular facts of each
situation. Therefore, it is important to consult legal counsel whenever utilizing
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is not engaged in recommending or referring members on the site or making claims
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From liability under
uninsured motorists provision.
In consideration of the payment to me of $_____ by
_________ Insurance Company of _________(company), which I acknowledge
receiving, I fully and forever release and discharge company from any and all
claims and demands, actions and causes of action, which I may have against
company under the family protection against uninsured motorists endorsement
attached to policy No. _________, because of the injury [death] of _________,
resulting or to result from that certain accident on or about _________[date]
at or near _________[e.g., the intersection of _________], County of
_________, State of _________.
I have not made any settlement with or prosecuted to
judgment any action against any person or organization who may be legally
liable for bodily injury on account of which company is making this payment.
Such person or organization, wherever mentioned in this release and trust
agreement, shall include _________ and also any person or organization who may
be liable for that bodily injury under [statutory reference], or any law
amending it.
I agree that this settlement is in full compromise of
a doubtful and disputed claim of liability and that the payment is not to be
construed as an admission of liability.
I further agree that in consideration of this payment:
(a). Any amount which I may be entitled to recover
from any person who is an insured under the bodily injury liability coverage of
the policy shall be reduced by the amount of this payment.
(b). Company shall be entitled to the extent of this
payment of $_____ to the proceeds of any settlement or judgment that may result
from the exercise of any rights of recovery I may have against any person or
organization legally responsible for the bodily injury because of which this
payment is made.
(c). I shall hold in trust for the benefit of company
all rights of recovery to the extent of the payment of _________ which I shall
have against such other person or organization because of the damages which are
the subject of claim made under the family protection against uninsured
motorists endorsement.
(d). I shall do whatever is proper to secure, and
shall do nothing after loss to prejudice, such rights.
(e). If requested in writing by the company, I shall
take, through any representative designated by company, and provided the
company pays all attorney's fees, costs and expenses, such action as may be
necessary or appropriate to recover such payment as damages from such other
person or organization, such action to be taken in my name. In the event of a
recovery, company shall be reimbursed out of such recovery for expenses, costs
and attorneys' fees incurred by it in connection with it.
(f). I shall execute and deliver to company such
instruments and papers as may be appropriate to secure my rights and
obligations and those of the company established by this provision.
Our Spam Policy
We hate getting spam as much as you do. So we have implemented a tough spam policy
regading how we deal with your email. We pledge that we will:
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party without your explicit consent
Terms Of Use
Submissions to this site, including any legal or business forms, posts, responses
to questions or other communications by contributors are not intended as and should
not be construed as legal advice. You are strongly encouraged to consult competent
legal council before engaging in any action based upon content contained on this
site.
These downloadable forms are only for personal use. Retransmission, redistribution,
or any other commercial use is prohibited. This includes reposting forms from this
site to another site offering free legal or other document forms for download.
Please note that the donator may have included different usage terms regarding this
form, and you agree to abide by these terms. It is highly recommended that you have
a licensed attorney review any legal documents for which you are searching in order
to make sure that your needs are being properly and completely satisfied.
Your use of this site constitutes your acceptance of our terms of use and your agreement
to hold this site, its officers, employees and any contributors to this site harmless
for any damage you might incur from your use of any submissions contained on this
site. If you do not agree to the above terms, please do not proceed.
These forms are provided to assist business owners and others in understanding important
points to consider in different transactions. They are offered with the understanding
that no legal advice, accounting, or other professional service is being offered
by these documents or on this website. Laws vary in the different states. Agreements
acceptable in one state may not be enforced the same way under the laws of another
state. Also, agreements should relate specifically to the particular facts of each
situation. Therefore, it is important to consult legal counsel whenever utilizing
these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com
is not engaged in recommending or referring members on the site or making claims
about the competence, character or qualifications of its participating members.
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Keywords: legal forms, uninsured motorists, liability
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