Receipt & Release
Date:
To:
Vessel:
Date:
Location:
Nature of claim:
Amount of claim:
Bill of Lading:
We hereby acknowledge receipt from
words:
, sum
of
, ( in
) which amount we accept as full and final settlement and satisfaction of
the above mentioned claim for compensation, loss, damage, expenses, costs, interests and/or
any other claims as described above.
We do hereby acknowledge and declare that upon payment of the above amount, we have no
further claims of whatsoever nature against the owners/operators/insurers of the vessel or any
other persons or companies directly or indirectly connected with the aforesaid ship/shipment,
or any other claims against you or the above vessel and/or her sister ships in the same
ownership in respect of the aforementioned claim.
We recognise that the above sum is paid to us by way of amicable settlement and we hereby
give full, complete and final discharge.
Finally we do hereby declare that we are the persons entitled to settle the claim and to receive
the aforesaid money which we do hereby undertake to indemnify _ in respect of any further
claims or any claims of whatsoever nature resulting from the above mentioned incident.
Faithfully yours,