Private Settlement Form Details

You will find more information about the settlement form motor accident by checking out the table we compiled for you.

QuestionAnswer
Form NameSettlement Form Motor Accident
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesprivate car accident settlement form, private settlement for motor accidents, settlement form auto, private settlement agreement template

Form Preview Example

PRIVATE SEtLEMENT FOR MOTOR ACCIDENTS

When involved in a motor accident, you are required to report accident (whether claiming under own policy or not) with accident vehicle (whether damage or not) to our reporing centres within 24 hours or the next working day ater the accident. Failure to report or late reporing of accident will result in insured’s NCD reducion, upon the next renewal of your motor policy.

You can choose to enter into a private setlement with the owner of the other car if there are no personal injuries and damages are minor. Under a private setlement, both paries agree to setle the mater amicably without suing each other. It is a legally binding agreement.

NTUC Income policyholders should send the signed form to Fax No. 6338 1500 or email atachment to motor@income.com.sg. NTUC Income will then take up the case on your behalf should the other party decide to lodge a claim subsequently. Your NCD will be protected even if we have to pay the claim.

NTUC Income collects, uses and discloses the informaion in this claim form for insurance and claims administraion purposes. For more details about NTUC Income’s Privacy

Policy, please visit www.income.com.sg/others/privacy.asp

PRIVATE SEtLEMENT

1.Details of Accident:

 

Date (dd/mm/yyyy) / Time :

 

 

 

 

 

 

Locaion :

 

 

 

 

 

2a.

Motor-vehicle registraion no.

 

 

driven by

 

 

 

 

 

(Name & NRIC no)

 

and owned by

 

 

 

 

 

 

 

 

 

 

(Name & NRIC no).

2b.

Motor-vehicle registraion no.

 

 

driven by

 

 

 

 

 

(Name & NRIC no)

 

and owned by

 

 

 

 

 

 

 

 

(Name & NRIC no).

3.There are no personal injuries or death involved.

4.The paries have agreed to setle this mater amicably as follows: *delete a) or b) as applicable.

*a. Neither party shall be liable to compensate the other party for any loss or damages (direct or indirect) incurred or to be incurred as a result of the accident.

*b. Without any admission of liability, (party paying compensaion) has paid a sum of $

 

which (owner receiving

compensaion) hereby acknowledges receipt thereof in full and final setlement of all damages and costs incurred and/or to be incurred as a

result of the accident.

5.Both paries have not and will not make a police report of this accident.

6.We understand that the informaion collected on this private setlement form will be kept and used by NTUC Income for invesigaing and administering claims, fraud detecion and underwriing future insurance applicaions.

Name (paying party):

 

 

 

 

 

 

 

Tel:

 

 

Fax:

 

NRIC / Passport no:

 

 

Signature :

 

 

 

 

 

 

 

 

Name (owner receiving compensaion):

 

 

 

 

 

 

Tel:

 

 

Fax:

 

NRIC / Passport no:

 

 

Signature :

 

 

 

 

 

 

NTUCINCOME/MTCL/PRIVATESETTLE/05/2014 • Page 1 of 1

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