release (sample)

[Sample only - must be reviewed by legal counsel]

Release of Accident Claims


The undersigned _________________________________ (“Releasor”) does hereby  acknowledges receipt of $_____ in exchange for Releasor and Releasor’s heirs, executors, administrators, and personal representatives, release and forever discharge of _________________________________ (“Releasee”) and Releasee’s agents, insurance companies, servants, successors, heirs, executors, administrators, and personal representatives, from all actions, any and all manner of claims, demands for or by reason of any damage, causes of action or suits, including but not limited to claims and suits for bodily injuries that Releasor had, might now have, or that might subsequently accrue to Releasor by reason of, or in any way directly or indirectly, connected with, or arising out of the accident occurring on or about ___________________________ (date of the automobile incident) at _______________________________________________________________________
_____________________________________________________ (location of the incident) between the following two vehicles:

Vehicle #1 (Releasor’s vehicle)
Year________ Make_____________ Model_____________ VIN #__________________________
Vehicle #2 (Releasee’s vehicle)
Year________ Make_____________ Model_____________ VIN #__________________________

For the same consideration, the Releasor further agrees not to make any claims or undertake any proceedings against the Releasee or any other person or entity which may claim contribution or indemnity under the provisions of any statute or otherwise.

The Releasor agrees to take full financial responsibility for any and all repairs of damages to only Releasor’s vehicle and/or Releasor’s personal property caused by the incident stated herewith.

Furthermore, the Releasor declares that he/she has not engaged into any actions, claims, demands, causes of action or suits, including but not limited to claims and suits for bodily injuries related to the aforementioned accident preceding the execution of this Release of Accident Claims. 

I hereby waive the provisions of section 1542 of the California Civil Code, which states: 
"A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor."

IN WITNESS WHEREOF the Releasor has executed this Release on ___________________________                                              
(handwritten date by Releasor)
 

_____________________________
(Signature of Releasor)

_____________________________
(Print Name)

_____________________________
(Driver License Number of Releasor)

_____________________________
(Current Address)

_____________________________
(City, State, Zip)
_____________________________
(Signature of Releasee)

_____________________________
(Print Name)

_____________________________
(Driver License Number of Releasee)

_____________________________
(Current Address)

_____________________________
(City, State, Zip) 

 
 

_____________________________
(Signature of Releasor)

_____________________________
(Print Name)

_____________________________
(Driver License Number of Releasor)

_____________________________
(Current Address)

_____________________________
(City, State, Zip)
 
 
___________________________
(handwritten date by Releasee)

_____________________________
(Signature of Releasee)

_____________________________
(Print Name)

_____________________________
(Driver License Number of Releasee)

_____________________________
(Current Address)

_____________________________
(City, State, Zip) 

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