"Private Settlement Form" - Singapore

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Download "Private Settlement Form" - Singapore

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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
:
Name
:
NRIC
:
NRIC
:
Signature
:
Signature
:
Date
:
Date
:
(Paying Party)
(Party receiving compensation)
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
:
Name
:
NRIC
:
NRIC
:
Signature
:
Signature
:
Date
:
Date
:
(Paying Party)
(Party receiving compensation)