Private Settlement Form printable pdf download

Private 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)

(Party receiving compensation)

Private Settlement Form