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    Insurance Company and Will Not Seek Additional Money: For Any Liabilities After The Repair Are Made

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    Richard Kazandzhidi
    This document is an agreement for $________ in payment to repair an automobile that was in an accident with _________________ on ____________. By signing, the recipient agrees not to submit an insurance claim or seek additional money after the agreed repairs are made. The agreement is signed by the recipient and witnessed by two people.

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    Insurance Company and Will Not Seek Additional Money: For Any Liabilities After The Repair Are Made

    Uploaded by

    Richard Kazandzhidi
    2 views1 page
    This document is an agreement for $________ in payment to repair an automobile that was in an accident with _________________ on ____________. By signing, the recipient agrees not to submit an insurance claim or seek additional money after the agreed repairs are made. The agreement is signed by the recipient and witnessed by two people.

    Original Description:

    ;p;

    Original Title

    February 28 2004

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    This document is an agreement for $________ in payment to repair an automobile that was in an accident with _________________ on ____________. By signing, the recipient agrees not to submit an insurance claim or seek additional money after the agreed repairs are made. The agreement is signed by the recipient and witnessed by two people.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    2 views1 page

    Insurance Company and Will Not Seek Additional Money: For Any Liabilities After The Repair Are Made

    Uploaded by

    Richard Kazandzhidi
    This document is an agreement for $________ in payment to repair an automobile that was in an accident with _________________ on ____________. By signing, the recipient agrees not to submit an insurance claim or seek additional money after the agreed repairs are made. The agreement is signed by the recipient and witnessed by two people.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    of 1

    I___________________________,hereby affirm that as per

    Our mutual agreement, I will accept payment in the amount of


    $___________for repair of my automobile which was involved
    in an accident with______________________on ___________
    according to the good faith estimate.
    BY my signature, I will not submit this claim with any
    Insurance company and will not seek additional money
    For any liabilities after the repair are made.

    Signed_____________________________________________
    This day of
    _________________________

    ____________________
    Witness

    _________________________

    ____________________
    Witness

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