PRIVATE SETTLEMENT(No Personal Injuries / Minor Damages)

Details of Accident :-

Date/ Time:

Location:

Motor-vehicle Registration no,

driven by (Name & NRIC/Fin no)

(Name & NRIC/F|n no).and owned by

Motor-veh

driven by

icle Registration no,

(Name & NRIC/F|n no)

and owned by (Name & NRIC/F|n no),

There are no personal injuries or death involved,

The parties have agreed to settle this matter amicably as follows: xdelete a) or b) as applicable.

xa. Neither pafi shall be liable to compensate the other party for any loss or damages (direct orindirect) incurred or to be incurred

xb. Without any admission of liability,

as a result of the accident.

(paying

pafty) has paid a sum of $ (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,

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

Name:

Tel:

(paying pafty)

NRIC/F|n no:

Signature:

Name:

I cl.

(owner receiving compensation)

Signature:

NRIC/Fin no: