Consent Letter Sunita Devi

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CONSENT LETTER FOR CASHLOSS

SETTLEMENT

Date: - / / /
To
The Manager
Digit General Insurance Co. Ltd
Atlantis, 95, 4th B Cross Road,
Koramangala Industrial Layout,
5th Block,
Bangalore 560095

I/We SUNITA DEVI had obtained a comprehensive


insurance policy from Go Digit General Insurance
Ltd. under policy No. D062236449 in respect of my
vehicle Reg. No. BR31AS-6459, Engine No.
JC89EG1073368 & Chassis No. ME4JC897BNG073106
having policy period from 16-Apr-2022 to 15-Apr-2023
During the existence of the above-mentioned policy, the
said vehicle met with an accident, and sustained loss on
11-APR-2023.
That Insurance company has duly informed the
assessment and parameters of assessment. After the mutual
discussion, I have voluntarily accepted settlement on Cash
loss Basis, further I hereby submit that salvage/damaged
vehicle will be retain by me.
That cash loss amount arrived at after a mutual
discussion is acceptable to me and I undertake not to raise
any issue or legal dispute regarding the same. I am
retaining the salvage and I have agreed to accept the sum of
Rs. 60,719 /- less policy excess Rs. 100/- (Rupees In words
Only) as a mutually negotiated settlement on cash loss
basis subject to policy cancellation from the date of loss. I
undertake that I will never raise an issue or litigate on this
mode of mutually agreed Cash loss settlement. My Insurers
are not at all liable for any Expenses/cost/charges/penalty.
That I further undertake that further responsibility relating
to salvage and its disposal will be upon me and Insurance
Company will not be liable for whatsoever reason
regarding further use as well as disposal of damaged
vehicle/salvage. I further undertake that I will follow
guidelines provided by Motor Vehicle Act relating to
further disposal/use of said vehicle.
I further undertake that said settlement will be bound
on me as well as on my predecessor, successor, executant,
legal heirs and assignees and no dispute/litigation will be
raise in future regarding said claim settlement. I undertake
that. If any dispute/litigation raise by me or my
predecessor, successor, executant, legal heirs, and assignees
regarding payment made under said claim then GO Digit
General Insurance Ltd will not be liable for the same and
shall not be made party to any dispute or litigation. I/We
Hereby undertake that If any cost, expenses incurred by Go
Digit General Insurance Ltd due to such dispute or
litigation, then ,I/We will refund/indemnify to Go Digit
General Insurance ltd for such loss and expenses.
This consent letter has been voluntarily given and I am
aware that the same is a condition precedent for the
mutually agreed mode of settlement.

Date:

(Name & Signature of Insured)

(Name & Signature of Witness)

Enclosures:-
Aadhar Card - 3956 2129 1802
Pan Card - DHEPD5895N

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