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    Release of Claim GSIS

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    Cruz
    This 3 sentence summary provides the key details from the document: The document is a release of claim and subrogation receipt from the Government Service Insurance System (GSIS) for PHP 17,549 paid to an individual for injuries sustained in an accident on March 31, 2019 in Quezon City. It releases GSIS from any future claims related to the accident and allows GSIS to recover costs from other liable parties. The individual acknowledged understanding the document which was notarized on June 28, 2019.

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    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Release of Claim GSIS

    Uploaded by

    Cruz
    245 views1 page
    This 3 sentence summary provides the key details from the document: The document is a release of claim and subrogation receipt from the Government Service Insurance System (GSIS) for PHP 17,549 paid to an individual for injuries sustained in an accident on March 31, 2019 in Quezon City. It releases GSIS from any future claims related to the accident and allows GSIS to recover costs from other liable parties. The individual acknowledged understanding the document which was notarized on June 28, 2019.

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    release of claim GSIS

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    This 3 sentence summary provides the key details from the document: The document is a release of claim and subrogation receipt from the Government Service Insurance System (GSIS) for PHP 17,549 paid to an individual for injuries sustained in an accident on March 31, 2019 in Quezon City. It releases GSIS from any future claims related to the accident and allows GSIS to recover costs from other liable parties. The individual acknowledged understanding the document which was notarized on June 28, 2019.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    245 views1 page

    Release of Claim GSIS

    Uploaded by

    Cruz
    This 3 sentence summary provides the key details from the document: The document is a release of claim and subrogation receipt from the Government Service Insurance System (GSIS) for PHP 17,549 paid to an individual for injuries sustained in an accident on March 31, 2019 in Quezon City. It releases GSIS from any future claims related to the accident and allows GSIS to recover costs from other liable parties. The individual acknowledged understanding the document which was notarized on June 28, 2019.

    Copyright:

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

    PASEGURUHAN NG MGA NAGLILINGKOD SA PAMAHALAAN

    (GOVERNMENT SERVICE INSURANCE SYSTEM)


    Financial Center, Macapagal Boulevard, Pasay City

    REFERENCE NO. :

    RELEASE OF CLAIM AND SUBROGATION RECEIPT


    FOR THE SOLE CONSIDERATION OF PESOS: Seventeen Thousand Five Hundred Forty
    Nine (Php 17, 549.00) the receipt of which is hereby acknowledged, I/We ___________for
    myself/ourselves, heirs Representatives, successors and assignee, do hereby release and discharge
    Government Service Insurance System from all actions, claims, demands and rights of action
    whatsoever that may exist or may hereafter develop and particularly on account of all known,
    unknown, and unanticipated injuries, damages and/or losses arising out of an as a consequence of an
    accident that occurred on or about March 31, 2019 at Quezon City.

    I/We further agree that this Release may be pleaded against me/us to any suit or proceedings
    which I/We, or anyone on my behalf, may have taken or may take in connections with this accident;
    that his payment or service is not an admission of liability by the party/ies hereby released and is
    voluntarily accepted in full and final compromise and settlement of the claim.

    It is further agreed that Government Service Insurance System is hereby subrogated to all
    rights of recovery by the undersigned on all the aforesaid claims, demands and rights of all actions
    from whomsoever may be liable therefore, and is hereby authorized to institute whatever legal
    proceedings necessary for the endorsement thereof, and to present compromise or withdraw the same,
    in the name of the undersigned or in its name.

    I/We manifest, that the term of this release have been read and/or translated to me in English,
    a dialect known to me and that I fully understand the content and import of the same.

    IN WITNESS WHEREOF, I have hereto affixed my hand this 28th of June 2019.

    WITNESSES
    ______________________ Government Issued ID._
    Issued at
    On

    REPUBLIC OF THE PHILIPPINES)


    MAKATI, METRO MANILA )S.S.

    Personally appeared before me at __________, Philippines this ____ day of __________ with
    Community Tax No. __________ issued at _________ on ______________ who executed the above Release
    and he/she acknowledge that the same is his/her free act and deed and I certify that before the execution thereof
    I have read and explained to him/her the contents and import thereof and he/she declared before execution of
    said Release that he/she fully understood the same.

    WITNESS MY HAND AND SEAL OF MY OFFICE.

    NOTARY PUBLIC

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