Written request to add a waiver of subrogation endorsement to one or more existing insurance policies in favor of a specified third party, as required by contract. Confirms the insured's agreement that the insurer will not pursue recovery against the named waived party.
The Waiver of Subrogation Request is a ready-to-use insurance & risk template you can send for signature in minutes. It is written for 1 signer (policyholder) and, by default, expires 14 days after it is sent if left unsigned. It covers waiver of subrogation, endorsement, subrogation, cg 24 04, workers comp, general liability. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
Document Preview
# Waiver of Subrogation Request **Request Date:** ___________ --- ## 1. Policyholder Information **Named Insured (as it appears on the policy):** ___________ **Named Insured Address:** ___________ **Named Insured Contact Name:** ___________ **Named Insured Contact Email:** ___________ **Named Insured Contact Phone:** ___________ --- ## 2. Insurance Agency / Broker **Agency / Brokerage Name:** ___________ **Agent / Broker Name:** ___________ **Agent / Broker Email:** ___________ **Agent / Broker Phone:** ___________ --- ## 3. Party in Whose Favor the Waiver Is Requested **Waived Party (entity or individual):** ___________ **Waived Party Address:** ___________ **Relationship of Waived Party to Named Insured:** ___________