本文发表在 rolia.net 枫下论坛Car Accident Private Settlement

1. Details of Accident:
Date( dd/mm/yyyy) Time:

Location:

2. Party A:
Motor-vehicle registration No. ________ Make:

driven by________________ ___ (Name& drive license number)

owned by_______________ _ (Name& drive license number)

Party B:
Motor-vehicle registration No. ________ Make:

driven by_________ (Name& drive license number)

owned by________ (Name& drive license number)

3. There are no personal injuries or death involved
4. The parties have agreed to settle this matter amicably as follows:

Without any admission of liability, (party paying compensation) has paid a sum of $____which ( owner receiving compensation) hereby acknowledges receipt thereof in full and final settlement of all damages and costs incurred and /or to be incurred as a result of the accident. Owner receiving compensation waives the right to any and all future claims against paying party

5. Both parties have not and will not make a police report of this accident.

Name (paying party):_______ ___________________ Ph:________
Address: _

Signature:___________________________________________________

Name (owner receiving compensation):___
Ph:_____
Address: ___________________________________________________
___________________________________________________________

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