VHI - Form of Undertaking - 1991

Members are advised that, following discussions with the VHI, the Society has agreed to recommend to its members a form of undertaking to be furnished to the VHI where the VHI has agreed to discharge hospital medical expenses for the client to the extent of his cover limits. The recommended fee payable to the solicitor in respect of such undertaking is £60 plus VAT. The form of authority to be completed by the member and the form of undertaking to be completed by the solicitor are set out hereunder.

Authority

In consideration of the VHI discharging my hospital and medical expenses to the extent of my cover limits, I undertake to the VHI to include these expenses as part of my claim against a third party(ies). I hereby irrevocably authorise the solicitor(s) representing me in making a claim to furnish to the VHI an undertaking in the following form:-

In consideration of the VHI discharging the hospital and medical expenses of my/our client (name), I/we hereby undertake to include as part of my/our client's (name) claim the monies so paid by the VHI (details of which are now supplied to us by the VHI) and subject to any order to the contrary, to repay to the VHI out of the proceeds that come into our hands the net amount recovered in respect of such payments made by the VHI.

Signed:

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Injured Member