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This Agreement is entered into this ____ of _____ 20__, in the City of Tagbilaran, Bohol,
Philippines, by and between:
____________________, of legal age, Filipino, and residing at
__________________________, Cebu, hereafter referred to as the FIRST
____________________, of legal age, Filipino and residing at
__________________________, Cebu City Philippines hereafter referred to as

WHEREAS, FIRST PARTY and SECOND PARTY are the accused and the private
complainant in Criminal Case. No. R-_______ entitled People of the Philippines vs.
___________ for Reckless Imprudence Resulting in Serious Physical Injury and Damage to
Property pending before the Municipal Trial Court in Cities in the City of ______________
(hereafter the Case) respectively;
WHEREAS, the Case stemmed from a vehicular accident (the Incident) which
occurred between a Toyota Corolla sedan with Plate No. _________ (the Car), then driven by
the FIRST PARTY and a motorcycle with several passengers and with Plate No. ___________,
then driven by _______________, the husband of SECOND PARTY on ________ 20__;
WHEREAS, as a result of the Incident and upon the complaint of the SECOND PARTY,
the Case was instituted against the FIRST PARTY;
WHEREAS, during the pendency of the Case several opportunities for discussions and
negotiations of a possible compromise on matters that are allowed to be compromised by
existing law were given to the parties by the court;
WHEREAS, after such negotiations and discussions the parties mutually realized and
deem it best and convenient to resolve the civil aspect of the case in an amicable manner in order
to avoid a protracted litigation;
WHEREAS, the SECOND PARTY had manifested its willingness to be indemnified a
reasonable value for whatever damage, suffering or loss that it had sustained by reason of the
Incident and the FIRST PARTY is likewise willing to meet the demands of the SECOND
WHEREAS, both parties have come to a mutually beneficial arrangement as to the
method of payment and mode of settlement of the civil aspect for its convenient and immediate
NOW THEREFORE, for and in consideration of the mutual covenants and agreements
herein established, the parties hereto agree as follows:

SECOND PARTY, by its own independent and voluntary assessment categorically
expresses that the only remaining balance of the damage, loss or suffering it incurred as a result
of the Incident, amounts to FIFTY THOUSAND PESOS (PhP50,000.00) which the FIRST
PARTY is willing to shoulder and pay.
FIRST PARTY, mindful of such loss and desirous to alleviate SECOND PARTYs
difficult condition as a result of the Incident agrees to pay the abovementioned amount in a
manner and term provided hereunder:

First half of the amount or TWENTY FIVE THOUSAND PESOS (PhP

25,000.00) shall be paid and given to the SECOND PARTY at the
execution of this Agreement, and receipt of which is hereunder
acknowledged by the SECOND PARTY;


The remaining balance of TWENTY FIVE THOUSAND PESOS (PhP

25,000.00) shall only be paid upon the actual receipt of the payment of the
insurance claim from the insurance company by the FIRST PARTY and/or
owner of the Car.

FIRST PARTYS payment shall not be taken to mean as an admission of any criminal
liability on its part. The execution of this Agreement by the parties however, hereby absolves and
releases the FIRST PARTY from any civil liability arising from the Incident if any. SECOND
PARTY recognized further that she had been compensated fully and adequately for any loss,
suffering or injury that she might have endured in connection with the Incident and therefore
undertakes not to file any claim or suit against the FIRST PARTY or any other person or entity
related to or involved in any manner with the Incident, including in particular the owner of the
Upon the execution of this Agreement, the Affidavit of Desistance executed by the
SECOND PARTY shall already be filed in the Case and the SECOND PARTY shall abide by the
matters declared therein as well as the terms of the Acknowledgment, Release and Waiver
executed by the SECOND PARTY on ___________ and this Agreement.
Both parties have executed this Agreement by their own voluntary act and deed and in
their mutually agreed terms. Both parties warrant further, that they did so with the full
understanding of its nature and its consequence to the pending Case.


Assisted by:

Assisted by:

ATTY. ________________

ATTY. _________________