INSURANCE CLAIM ASSIGNMENT AGREEMENT
Effective Date: [Date]
1. PARTIES AND RECITALS
1.1 This Insurance Claim Assignment Agreement ("Agreement") is entered into as of [Effective Date] by and between:
[Party A Full Legal Name] ("First Party"), [individual/entity] with an address at [Address];
and
[Party B Full Legal Name] ("Second Party"), [individual/entity] with an address at [Address].
1.2 WHEREAS, the Parties wish to establish the financial terms and obligations set forth herein.
1.3 NOW, THEREFORE, in consideration of the mutual promises and covenants contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:
2. FINANCIAL TERMS AND OBLIGATIONS
2.1 The principal amount, financial commitment, or transaction value under this Agreement shall be $[Amount] ("Principal Sum").
2.2 [Interest/Returns/Payments] shall be calculated at a rate of [Rate]% per [annum/month/quarter], computed on a [simple/compound] basis.
2.3 Payment Schedule: (a) [First Payment]: $[Amount] due on [Date]; (b) [Subsequent Payments]: $[Amount] due on the [day] of each [month/quarter]; (c) [Final Payment]: $[Amount] due on or before [Maturity Date].
2.4 All payments shall be made via [wire transfer/check/ACH] to the account designated by the receiving Party. Payments received after the due date shall be subject to a late fee of $[Amount] or [Percentage]% of the overdue amount.
3. REPRESENTATIONS AND WARRANTIES
3.1 Each Party represents and warrants that: (a) It has full legal authority to enter into and perform this Agreement; (b) The execution of this Agreement does not conflict with any other agreement or obligation; (c) All information provided in connection with this Agreement is true, accurate, and complete; (d) It is not subject to any pending litigation or regulatory action that would affect its performance.
3.2 [Specific Party] additionally represents that: (a) [Financial condition representation]; (b) [Regulatory compliance representation]; (c) [Collateral/security representation, if applicable].
4. DEFAULT AND REMEDIES
4.1 An "Event of Default" shall occur if: (a) Any payment is not made within [10] days of its due date; (b) A Party breaches any material representation, warranty, or covenant; (c) A Party becomes insolvent or files for bankruptcy protection; (d) A material adverse change occurs in a Party's financial condition.
4.2 Upon an Event of Default, the non-defaulting Party may: (a) Declare all outstanding amounts immediately due and payable; (b) Exercise any rights and remedies available under applicable law; (c) Terminate this Agreement upon written notice; (d) Pursue specific performance or injunctive relief.
5. SECURITY AND COLLATERAL
5.1 [If applicable] To secure the obligations under this Agreement, [Party] hereby grants a security interest in [Description of Collateral].
5.2 The secured Party shall have the right to file financing statements and take all actions necessary to perfect its security interest.
5.3 The pledging Party shall not sell, transfer, or encumber the collateral without prior written consent.
5.4 Upon full satisfaction of all obligations, the secured Party shall release its security interest and file appropriate termination statements.
6. TAX AND REGULATORY COMPLIANCE
6.1 Each Party shall be responsible for its own tax obligations arising from this Agreement, including income taxes, withholding taxes, and reporting requirements.
6.2 The Parties shall cooperate in providing any tax forms, documentation, or certifications reasonably requested.
6.3 This Agreement is intended to comply with all applicable financial regulations, including [relevant regulations]. If any provision is found to violate applicable law, it shall be modified to the minimum extent necessary.
7. INDEMNIFICATION
7.1 Each Party shall indemnify and hold harmless the other from any claims, losses, or expenses arising from breach of this Agreement or misrepresentation.
7.2 The indemnifying Party's obligations shall survive termination of this Agreement.
8. GOVERNING LAW
8.1 This Agreement shall be governed by and construed in accordance with the laws of the State of [State/Jurisdiction], without regard to its conflict of law provisions.
8.2 Any disputes arising under or in connection with this Agreement shall be resolved in the state or federal courts located in [County], [State], and each Party hereby consents to the jurisdiction of such courts.
9. SEVERABILITY
9.1 If any provision of this Agreement is held to be invalid, illegal, or unenforceable, the remaining provisions shall continue in full force and effect.
9.2 The invalid or unenforceable provision shall be modified to the minimum extent necessary to make it valid and enforceable.
10. ENTIRE AGREEMENT
10.1 This Agreement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior negotiations, representations, warranties, commitments, offers, and agreements, whether written or oral.
10.2 No amendment or modification of this Agreement shall be valid unless made in writing and signed by both Parties.
SIGNATURES
IN WITNESS WHEREOF, the Parties have executed this Agreement as of the date first written above.
[Party A Name] Signature: ___________________________ Name: [Full Legal Name] Title: [Title/Position] Date: [Date]
[Party B Name] Signature: ___________________________ Name: [Full Legal Name] Title: [Title/Position] Date: [Date]
DISCLAIMER: This template is provided for informational purposes only and does not constitute legal advice. Consult a qualified attorney before using this document to ensure compliance with applicable laws in your jurisdiction.
