This AGREEMENT [Incident of 22 May 2021], executed this ________ in Tagaytay City,Cavite, by and among:
DAVID BLAIR y CAMPBELL of legal age, Filipino, single/married, with residence address atLot 1 Block 11 Windsor Heights Residence East Tolentino Tagaytay 4120, hereinafter referredto as the FIRST PARTY; and
NAME OF PARTY of legal age, Filipino, single/married, with residence address at________________hereinafter referred to as the SECOND PARTY;
WHEREAS, the FIRST PARTY and the SECOND PARTY has been involved in a vehicularaccident in the evening of May 22, 2021 along Tagaytay-Santa Rosa Road, Barangay TolentinoEast, Tagaytay City being the drivers of a Ford F150 PICK-UP with plate no. C2X426 and aMotorstar Easyride 150 motorcycle, respectively ;
WHEREAS the vehicle of the FIRST PARTY has incurred unintimated damages on his vehicleparticularly on the front portion, rear door, right rear window and quarter panel thereof;
WHEREAS the motorcycle of the SECOND PARTY likewise incurred damages;
WHEREAS the SECOND PARTY sustained physical injuries and his two backriders thereatnamely, April Joy Baldonanza y Sanarez and Romel De Asas y San Roque, because of the saidaccident and is now being treated at the Ospital ng Tagaytay;
WHEREAS, both parties are desirous of settling amicably the incident, considering SECONDPARTY is well aware that he was under the influence of alcoholic beverages during the time ofincident and drove his motorcycle without driver’s license, as stated in the Police InvestigationReport executed;
NOW, THEREFORE, in consideration of the foregoing premises, the parties hereby undertake asfollows:
2. The parties agree to, release each other free from any liabilities and obligation/s whatsoeverresulting from the accident, including all claims and counterclaims therein, and agree not to file any case, whether civil, administrative or criminal, of any kind or nature whatsoever, in anycourt, tribunal, or government agencies exercising quasi-judicial function arising from the samefacts, incident, claim, cause or causes of action.
3. The parties hereby mutually, irrevocably, freely and voluntarily release and forever dischargeone another, from any and all manner of action, causes of action, sum of money, damages,liability, responsibility, obligation, claims and demands whatsoever in law or equity, which theyhad, now have, or may have against each other, including, but not limited to, actual, moral,exemplary and all other damages or causes of action provided for under the law, if any, arising,directly or indirectly, from the facts and circumstances, all of which claims or causes of action bythese presents the parties hereby abandon and waive.
4. This agreement shall not in any way be construed as an admission on the part of any party ofany fault, negligence or liability, of whatever kind and nature, in connection with theaforementioned accident.
5. The parties shall abide with the provisions of this compromise agreement in utmost good faith.
th IN WITNESS WHEREOF, the parties have hereunto set their hand this 22 2021 in Tagaytay City, Cavite.
__________________________ _______________________ DAVID BLAIR y CAMPBELL First Party Second Party
__________________________ _______________________ ACKNOWLEDGEMENT
BEFORE ME, a Notary Public, for and in the above jurisdiction, this __________________________personally appeared the following persons:
Name Competent Evidence of Identity
known to me and to me known to be the same persons who executed the foregoing instrument, and theyacknowledged to me that the same is their free and voluntary act and deed.
This instrument refers to the Deed of Absolute Sale, which consists of three (3) pages signed by the Parties on allpages including the one on which this acknowledgement is written.
IN WITNESS WHEREOF, I have hereunto affixed my signature and notarial seal on the date and place firstabove written.
Doc. No. ____;Page No. ____;Book No. ___;Series of 2021.
We, the spouses _____________ and _____________, both of legal ages, Filipinos, andresidents of _____________, Philippines, hereby DECLARE AND MANIFEST: That for and in consideration of the amount of _____________ (P_____________) in cash,in hand received by us to our full and complete satisfaction, and the payment and settlement by_____________ of the hospital and medical bills and expenses incurred by the _____________for injuries sustained, I, WE hereby absolutely release, completely clear, andforever discharge the said _____________ and his driver _____________ from any action, causeof action, sum of money, liability, damages, claims and demands whatsoever, which in law orin equity I/we have, or which I/we, our heirs, insurer, successors and assigns hereafter may haveupon or by reason of the injuries sustained by me/us, and the damage sustained by our_____________ motor vehicle with Plate No. ______________ arising from the accident whichhappened on _____________ at _____________ involving our said _____________ registeredin the name of the undersigned _____________ and the _____________ motor vehicle withPlate No. _____________ owned by the said _____________ with the intention to completelyand absolutely waive all our right of action, causes of action, claims and demands, of whatevernature, arising from, or in connection with the aforementioned accident.
I/We further warrant that I/we will institute no further action against the said _____________and/or his driver _____________ arising from, by reason of, or in connection with, theaforementioned vehicular accident. I/We also manifest that the said payment / settlement madeby the said _____________ shall not be taken by us, our heirs, our insurer or assigns, asa confession and/or admission of liability on the part of the said _____________ or by his driver_____________ in connection with the aforementioned accident.IN WITNESS WHEREOF, we have hereunto set our hands this _____________ at_____________, Philippines.
SIGNED IN THE PRESENCE OF: