AMICABLE SETTLEMENT

I _______________ of legal age, Filipino, single/married and a resident

of________________ hereto referred as the former party and I _____________________
hereto referred as the latter party do hereby agree to amicably settle the issues/
controversies arising out from the incident that happened on __________ (indicate
dd/mm/yy) which resulted to the death of one of the members of the family of the
latter party to wit:
1. The latter party has acknowledged that the former has no legal obligation or
liability arising out from the incident that had happened as a consequence
thereof we are of no interest to file further complaint against his person for
we have come up with the amicable settlement which would rest all issues
and controversies for we believe that it is never an intention and its purely
accidental.
2. It is thus, manifested that the latter party has acknowledged the utmost
sincerity and eagerness of the former party in extending financial support as
to medical needs and assistance to the family of the deceased right after the
incident happened.
3. It is agreed further that the former party shall pay all the medical and burial
expenses (that includes from the days of wake up to the burial rites) incurred
as a consequence to the incident.
In view of the above stipulation we are affixing our signatures below to further
attest and give effect to our agreement. Signed this ___________ day of __________
2015 at _____________________________.

ROLEN BILBAO
Former Party

________________ _______________________ ________________________

Latter Party

Witnesses:

1. __________________ (signature over printed name)

2. __________________ (signature over printed name)

Attested:

__________________
Punong Barangay