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Fillable Printable Private Car Accident Settlement Form

Fillable Printable Private Car Accident Settlement Form

Private Car Accident Settlement Form

Private Car Accident Settlement Form

Rev 01
PRIVATE SETTLEMENT FORM
1. Details of Accident
Date / Time:
Location:
2a. Motor-vehicle registration no. driven by
(Name & NRIC)
2b. Motor-vehicle registration no. driven by
(Name & NRIC)
3. There were no personal injuries or death involved.
4. The parties have agreed to settle this matter amicably as follows:
*a. Neither party shall be liable to compensate the other party for any loss or
damages (direct or indirect) incurred or to be incurred as a result of the
accident.
*b. without any admission of liability, (Party paying
compensation) has paid a sum of $_________ which
(Owner receiving compensation) hereby acknowledges receipt
there of in full and final settlement of all damages and cost incurred and/or
to be incurred as a result of the accident.
*c. That (Name & NRIC no.) have received the
aforesaid vehicle in good running order and damages that were caused as a
result of the above-mentioned accident were repaired to satisfaction.
5. Both parties have not and will not make a police report of this accident.
6. Both parties will not file any accident claims for this accident.
Name :
NRIC :
Signature :
Date :
(Paying Party)
Name :
NRIC :
Signature :
Date :
(Party receiving compensation)
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