MUTUAL RELEASE & DISCHARGE

1. The undersigned hereby finally and irrevocably mutually release and discharge each other from all liability to each other, and settle all possible actions and causes of action against each other including claiming from or reporting to the automobile insurance, for damages, loss or injury sustained by either of them, however arising, present and future, known and unknown at this time, relating to the car accident, namely,

Accident date, time and place:
Vehicle-A plate #, model and year make:
Vehicle-A driver’s name and DL’s #
Vehicle-B plate #, model and year make:
Vehicle-B driver’s name and DL’s # Name:

2. It is confirmed that no person suffering any injury resulting from the accident and therefore undertake not to claim/report to their respective insurers subject to paragraph 3 hereunder.
3. The driver of vehicle A agreed to accept payment of $ from vehicle B as an amicable settlement to the collision and payment thereof is hereby acknowledged.
4. It is further agreed that neither party to this mutual release and discharge will make any claim or take any proceedings against any person who might claim over against or claim contribution or indemnity from the other party in connection with the above accident for which this mutual release is given.
5. It is understood and agreed that nothing in this mutual release and discharge is to be construed as an admission of liability in connection with any matter for which this mutual release is given.

Executed in duplicate on [DATE].




Name (print):                                    Name (print):
Driver of vehicle A                              Driver of vehicle B