Fillable Printable Private Settlement for Motor Accidents Form

Private Settlement for Motor Accidents Form

NTUCINCOME/MTCL/PRIVATESETTLE/05/2014 • Page 1 of 1

Private se lement for motor accidents

When involved in a motor accident, you are required to report accident (whether claiming under own policy or not) with accident vehicle (whether damage or not) to our

repor ng centres within 24 hours or the next working day a er the accident. Failure to report or late repor ng of accident will result in insured’s NCD reduc on, upon the next

renewal of your motor policy.

You can choose to enter into a private se lement with the owner of the other car if there are no personal injuries and damages are minor. Under a private se lement, both

par es agree to se le the ma er amicably without suing each other. It is a legally binding agreement.

NTUC Income policyholders should send the signed form to Fax No. 6338 1500 or email a achment to [email protected]om.sg. NTUC Income will then take up the case on

your behalf should the other party decide to lodge a claim subsequently. Your NCD will be protected even if we have to pay the claim.

NTUC Income collects, uses and discloses the informa on in this claim form for insurance and claims administra on purposes. For more details about NTUC Income’s Privacy

Policy, please visit www.income.com.sg/others/privacy.asp

Private se lement

1. Details of Accident:

Date (dd/mm/yyyy) / Time :

Loca on :

2a. Motor-vehicle registra on no. driven by (Name & NRIC no)

and owned by

(Name & NRIC no).

2b. Motor-vehicle registra on no. driven by (Name & NRIC no)

and owned by

(Name & NRIC no).

3. There are no personal injuries or death involved.

4. The par es have agreed to se le this ma er amicably as follows: *delete a) or b) as applicable.

*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 compensa on) has paid a sum of $

which (owner receiving

compensa on) hereby acknowledges receipt thereof in full and ﬁ nal se lement of all damages and costs incurred and/or to be incurred as a

result of the accident.

5. Both par es have not and will not make a police report of this accident.

6. We understand that the informa on collected on this private se lement form will be kept and used by NTUC Income for inves ga ng and

administering claims, fraud detec on and underwri ng future insurance applica ons.

Name (paying party):

Tel: Fax:

NRIC / Passport no: Signature :

Name (owner receiving compensa on): Tel: Fax:

NRIC / Passport no: Signature :