Consent Letter

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CONSENT LETTER-for Theft Claim SETTLEMENT

I, ______________________________had obtained a comprehensive insurance policy from Reliance


General Insurance Co Ltd. Under policy No _________________________in respect of my vehicle No
________ the period from __________to ____________. During the existence of the said policy the said
vehicle got theft or I sustained loss on _________.

After the mutual discussion and negotiation I have voluntarily accepted full & final settlement of my Theft
claim

I have agreed to accept the sum of Rs. ___________/- less policy excess Rs.50/- = Rs.________/- as a
mutually negotiated full & final settlement for my theft of vehicle subject to policy cancellation from the
date of loss. I undertake that I will never raise an issue, or litigate on this settlement. My Insurers are not at
all liable for any other 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:.

Signature of Insured

Signature of Witness

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