Car Accident Private Settlement
1. Details of Accident:
Date ( ) Time:
Location:
2. Party A:
License Plate:
VIN:
Make:
driven by
owned by
Party B:
License Plate:
VIN:
Make:
driven by
owned by
3. There are no personal injuries or death involved
4. The parties have agreed to settle this matter as follows:
Without any admission of liability, ______ has paid a sum of $ which 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
Name (paying party):_________________________________
Signature:___________________________________________________
Name (owner receiving compensation):_______
Signature:___________________________________________________
Date: