REPUBLIC OF THE PHILIPPINES)
CITY OF TAGBILARAN) S.S.
AMICABLE SETTLEMENT
THIS SETTLEMENT AGREEMENT is entered into between:
1. _____________, of legal age, Filipino, single, a resident of __, Bohol,
Philippines, driver of a _____ bearing plate number __ which is lawfully
owned by _;
2. _____________, of legal age, Filipino, single, a resident of ____, Bohol,
Philippines, driver of a ____ bearing plate number ____ which is
lawfully owned by _;
WHEREAS, on _________, a vehicular accident transpired in
________________ between a ____ vehicle with plate number __driven by
_________, and ____ with plate number __ driven by __;
WHEREAS, both vehicles involved were seized and taken into legal custody by
the Philippine National Police of ___ Traffic Management in accordance with their
rules and procedures;
WHEREAS, the parties desire to enter into this Settlement Agreement to provide
for certain payments in full settlement and discharge of confiscated vehicles, and in
which are or might become the subject of a Complaint, upon the terms and
conditions set forth herein;
WHEREAS, the owner of ____ offers to pay PHP__ as payment for the cost of
repair of the ___, PHP __ to be given as partial payment and remaining balance to
be paid in full upon the approval and release of the insurance;
FINALLY, the parties hereby authorize the Chief of Police of ___ Station to
release the __ vehicle with plate number _ and _ with plate number _.
NOW THEREFORE, for and in consideration of the foregoing premises, __,
hereby agree to settle the dispute with ____ and pay the cost REPAIRS and
DAMAGES on the ___ called for herein. In case of breach, ___ reserve her right to
institute a formal complaint in proper court against the other parties who will be
liable for more charges which includes cost of litigation and damages.
IN WITNESS WHEREOF, we have hereunto affixed our hands this _________ at
Tagbilaran City, Philippines.
___________________ ___________________
Affiant Affiant
Signed in the presence of:
_____________________ _______________________
ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
CITY OF TAGBILARAN) S.S.
BEFORE ME, this ________________ in Tagbilaran City, Bohol, Philippines, personally
appeared:
NAME: VALID ID NO:
_______________________ ______________________________________
_______________________ ______________________________________
Known to me to be the same persons who executed the foregoing instrument and they
acknowledged to me that the same is their free act and voluntary deed.
IN WITNESS WHEREOF I have hereunto set my hand the day, year, and place first
above-written.
Doc. No. ____________
Page No. ____________
Book No. ____________
Series of 2022.
