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Motor Accident Private Settlement Agreement Motor Accident

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					Motor Accident Private Settlement Agreement


Motor Accident Private Settlement Agreement


Accident Date: _______________                     Accident Time: _________________

Accident Location: ______________________________________________________

_____________________________________________________________________

Accident Description: ___________________________________________________

_____________________________________________________________________


This serves to confirm that the undersigned parties involved in the captioned accident have
privately and amicably settled and resolved any and all property damage and / or injury claims
arising from the road traffic accident.

We agree not to file any and further property damage and /or injury claims against each other and
the Motor insurance companies now or in the future either personally, via the vehicle owner or
repairer, or through lawyers.

We further agree to indemnify and hold harmless each other against any and further claims that
may arise from other interested or involved parties.


Signature and Details of Drivers
Vehicle A                                          Vehicle B


___________________________                        ___________________________
Driver Name & IC Number                            Driver Name & IC Number


___________________________                        ___________________________
Driver Signature & Date                            Driver Signature & Date


___________________________                        ___________________________
Vehicle Licence Number                             Vehicle Licence Number




Public                                        Page 1 of 2                          03/06/2010
Motor Accident Private Settlement Agreement




Signature and Details of Passengers, if required
Details of consenting passengers involved who are also bound by this agreement.

Vehicle A                                                 Vehicle B


___________________________                               ___________________________
Passenger 1 Name & IC Number                              Passenger 1 Name & IC Number

___________________________                               ___________________________
Passenger 1 Signature & Date                              Passenger 1 Signature & Date

___________________________                               ___________________________
Vehicle A Licence Number                                  Vehicle B Licence Number




___________________________                               ___________________________
Passenger 2 Name & IC Number                              Passenger 2 Name & IC Number

___________________________                               ___________________________
Passenger 2 Signature & Date                              Passenger 2 Signature & Date

___________________________                               ___________________________
Vehicle A Licence Number                                  Vehicle B Licence Number




___________________________                               ___________________________
Passenger 3 Name & IC Number                              Passenger 3 Name & IC Number

___________________________                               ___________________________
Passenger 3 Signature & Date                              Passenger 3 Signature & Date

___________________________                               ___________________________
Vehicle A Licence Number                                  Vehicle B Licence Number




Public                                             Page 2 of 2                      03/06/2010