This form is a sample letter in Word format covering the subject matter of the title of the form.
[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Recipient's Name] [Recipient's Address] [City, State, ZIP] Subject: Itemized Settlement Statement Dear [Recipient's Name], I am writing to provide you with a detailed itemization of the settlement for the [case/reference number] regarding the [nature of the case]. This letter aims to outline the various charges, credits, and deductions related to the settlement. Please review the content thoroughly and feel free to contact me with any questions or concerns. 1. Settlement Amount: The total settlement amount for this case is $[total settlement amount]. This includes all damages, compensations, and any other agreed-upon financial terms between the parties involved. 2. Damages and Compensations: a) Medical Expenses: The medical expenses incurred due to [reason for medical expenses] amount to $[medical expenses amount]. b) Lost Wages: The loss of income due to [nature of lost wages] totals $[lost wages amount]. c) Pain and Suffering: The psychological and emotional distress caused by the incident amounts to $[pain and suffering amount]. d) Property Damage: The value of the property damage, including repairs or replacement of [damaged property], is $[property damage amount]. 3. Attorney Fees and Costs: a) Legal Fees: The attorney fees associated with this case amount to $[legal fees amount]. b) Court Costs: The expenses incurred during the legal process, such as filing fees, deposition fees, and expert witness fees, sum up to $[court costs amount]. 4. Insurance Deductions: a) Health Insurance: Deducted from the settlement amount is the reimbursement owed to [health insurance provider] for covering the medical expenses. The total deduction is $[health insurance deduction amount]. b) Disability Insurance: [Disability insurance provider name] is entitled to a deduction of $[disability insurance deduction amount] for covering the lost wages. 5. Net Settlement Amount: After subtracting the aforementioned deductions from the total settlement amount, the net settlement amount payable to [Recipient's Name] stands at $[net settlement amount]. This amount will be paid to you within [specified timeframe] via [mode of payment]. Please note that by accepting this settlement, you are acknowledging that it fully resolves all claims related to [nature of the case] against [Company/Individual name] and releases them from any further liability. Should you have any questions or require additional information, please do not hesitate to contact me at [your contact information]. I am here to address any concerns you may have. Thank you for your attention to this matter, and I look forward to resolving this case satisfactorily. Sincerely, [Your Name]
[Your Name] [Your Address] [City, State, ZIP] [Email Address] [Phone Number] [Date] [Recipient's Name] [Recipient's Address] [City, State, ZIP] Subject: Itemized Settlement Statement Dear [Recipient's Name], I am writing to provide you with a detailed itemization of the settlement for the [case/reference number] regarding the [nature of the case]. This letter aims to outline the various charges, credits, and deductions related to the settlement. Please review the content thoroughly and feel free to contact me with any questions or concerns. 1. Settlement Amount: The total settlement amount for this case is $[total settlement amount]. This includes all damages, compensations, and any other agreed-upon financial terms between the parties involved. 2. Damages and Compensations: a) Medical Expenses: The medical expenses incurred due to [reason for medical expenses] amount to $[medical expenses amount]. b) Lost Wages: The loss of income due to [nature of lost wages] totals $[lost wages amount]. c) Pain and Suffering: The psychological and emotional distress caused by the incident amounts to $[pain and suffering amount]. d) Property Damage: The value of the property damage, including repairs or replacement of [damaged property], is $[property damage amount]. 3. Attorney Fees and Costs: a) Legal Fees: The attorney fees associated with this case amount to $[legal fees amount]. b) Court Costs: The expenses incurred during the legal process, such as filing fees, deposition fees, and expert witness fees, sum up to $[court costs amount]. 4. Insurance Deductions: a) Health Insurance: Deducted from the settlement amount is the reimbursement owed to [health insurance provider] for covering the medical expenses. The total deduction is $[health insurance deduction amount]. b) Disability Insurance: [Disability insurance provider name] is entitled to a deduction of $[disability insurance deduction amount] for covering the lost wages. 5. Net Settlement Amount: After subtracting the aforementioned deductions from the total settlement amount, the net settlement amount payable to [Recipient's Name] stands at $[net settlement amount]. This amount will be paid to you within [specified timeframe] via [mode of payment]. Please note that by accepting this settlement, you are acknowledging that it fully resolves all claims related to [nature of the case] against [Company/Individual name] and releases them from any further liability. Should you have any questions or require additional information, please do not hesitate to contact me at [your contact information]. I am here to address any concerns you may have. Thank you for your attention to this matter, and I look forward to resolving this case satisfactorily. Sincerely, [Your Name]