This Release of Accident Claims fully releases and forever discharges a party from any future claims arising from a motor vehicle accident. This Release sets forth any sums paid in consideration of this Release and that the party signing the release does so voluntarily for settlement of all claims.
RELEASE OF ACCIDENT CLAIMS
FOR AND IN CONSIDERATION OF THE SUM OF _____________________ Dollars, the receipt and sufficiency of which is hereby acknowledged, I ______________________ of ______________________________ hereby fully release and forever discharge ___________________________ of ________________________________, its heirs, executors, administrators, agents and assigns, and all other persons, firms or corporations liable or who might be claimed to be liable,(collectively the “Releases”) from any and all claims, demands, damages, actions, causes of action of any kind or nature whatsoever that I now have or may hereafter have arising out of, in consequence of or on account of all injuries, known and unknown, to person and property, including any latent injuries and all developments and results arising therefrom, whether known or unknown injuries, whether developed or undeveloped, and anticipated or unanticipated consequences of all such injuries, and damages resulting to me in any way from an accident which occurred on or about the __________ day of __________, 20 __, at or near _____________________________ involving _______ motor vehicles, in one of which I was a passenger.
By accepting the above mentioned sum, I hereby release and discharge that fraction, portion or percentage of the total cause of action of claim for damages I now have or may hereafter possess against all parties responsible for my damages.
I hereby declare that I have fully read and understood the terms of this settlement and I have voluntarily accepted for the purpose of making a full and final compromise adjustment and settlement of any and all claims.
IN WITNESS WHEREOF I have executed this Release on ______________________
_____________________________
(Signature)
_____________________________
(Print Name)
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