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English to Chinese: Authorization to Obtain and Release Information (Excluding Psychotherapy Notes) General field: Medical Detailed field: Insurance
Source text - English I understand the Company or Plan Sponsor will use the information obtained under this Authorization or directly from me to
determine eligibility for insurance benefits, which may include assessing ongoing treatment. Any information obtained will not be
released to any person or organizations EXCEPT to the Plan Sponsor, reinsuring companies,other companies in the Liberty Mutual
Group of companies to which I am submitting a claim, Employee Assistance Programs (EAP) or other disease management or
assistance programs providing services to the Plan Sponsor and/or to the Company, persons or other organizations providing claims
management and claim advisory services to the Plan Sponsor and/or to the Company, the Group Policyholder and its agents/vendors
for purposes of auditing the Company’s administration of claims under the policy and/or assessing statistical claim data related to its
benefit programs, persons or organizations providing medical treatment or services in connection with my claim, or as may be other
wise permitted or required by law. I also understand that, to the extent reasonably necessary, information obtained may be released
to other insurance companies or insurance support organizations to detect or prevent criminal activity, fraud, material
misrepresentation, or material non-disclosure in connection with insurance transactions.
I understand that this authorization is valid for two years from the date appearing below with my signature. I understand that I have
a right to request and receive a copy of this authorization. I understand that I have the right to revoke this Authorization at any time
by notifying the Plan Sponsor and/or the Company in the Liberty Mutual group of companies for which I submit a claim. If I do not
sign this authorization or if I alter or revoke it, Liberty may not be able to evaluate my claim(s), which may lead to my claim(s)
being denied. I understand that revocation will not apply to any information that is requested prior to Liberty receiving notice of
revocation.
Translation - Chinese 本人明白此公司或受保方会用我直接提供的或由此授权书所拿到的资料， 来决定我是否应领取保险福利金， 并授权其继续获取我今后的看病记录。所有资料不会被转给某个人或组织，但是可以转给受保方，再保险公司以及受理我理赔案的利保集团内部公司， 员工协助项目（EAP）或其它疾病管理机构或为受保方，及/或为利保公司，集团之受险人以及代理人/销售商提供协助项目的处理公司，保单理赔管理审计和/及查看福利金额数据之有关部门，同我理赔有关之治疗的医护人员或机构，或其它法律允许或要求者。本人还明白，在合理范围内，所有资料会转给其它保险公司或保险辅助机构，以杜绝或防止犯罪行为如伪造罪，误传文件，或保险交易中的泄密问题。
English to Chinese: SETTLEMENT AGREEMENT AND RELEASE OF ALL CLAIMS General field: Other Detailed field: Law (general)
Source text - English IN CONSIDERATION of the payment of Two Hundred and Fifty Dollars .xx/100 ($250.00), receipt of which is hereby acknowledged by, xxx residing at xxx, Ambler, PA 19002 (hereinafter the undersigned”),for my/our self(ves) spouse(s), children, agents, heirs, representatives, executors, predecessors, successors and assigns, release and forever discharge, xxxxxxx Ice Cream Inc, (hereinafter “XXX’s”) and its shareholders, subsidiaries, affiliates, divisions, officers, directors, employees, agents, representatives, insurers, predecessors, successors and assigns and all other persons, firms, companies, and corporations and/or independent contractors (including, but not limited to, all distributors, handlers, brokers, prepared food purveyors, wholesale sellers, retail sellers, grocery stores and/or chains and all other such parties charged or chargeable with responsibility), of and from any and all claims, demands, debts, damages, actions or causes of action, injuries, loss of use, loss of services, medical or dental expenses or any other liabilities arising out of or in any way connected with the incident occurring on or about, 04/29/2013 at or near involving product: xxxxx Choc Chip 14 OZ.
The undersigned further covenant(s) and agree(s) to protect, indemnify, and hold harmless XXXs and its shareholders, subsidiaries, affiliates, officers, directors, employees, agents, representatives, insurers, predecessors, successors and assigns, and independent contractors of and from any further loss, damage or expense by reason of litigation or otherwise arising out of or in any way connected with the subject claim.
Translation - Chinese
结算协议及了结全部索赔案同意书
XXX(XXX)，现住址XXX Ave, Ambler, PA 19002，现收到贰百五十美元整（$250.00），（以下简称签字方），条件是，从此，我／我们，我的配偶，孩子，代理人，后嗣，代表，执行人，先人，后人及继承人，转让，放弃，并永远不再追究责任于XXXX 冰淇凌公司（以下简称XXX)及其持股人，下属机构，附属机构，分部，办公室，总管，员工，代理人，代表，保险公司，先人，后人及转让者和其他人员，商号，公司，独立承包商（包括，但不限于，所有分销商，处理人，中间人，加工食品承办商，批发商，零售商，食品商店和/或其连锁店以及所有其他被控有责任方，签字方不再提起索赔，要求，债务赔偿，损坏赔偿，行为或行为原因赔偿，受伤赔偿，缺失赔偿，服务损失赔偿，医疗或牙科费用赔偿， 或由２０１３年４月２９日由XXXX Chip 14 OZ或类似产品所发生之事件造成或有关系的所有责任。
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