AMICABLE SETTLEMENT/AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This AMICABLE SETTLEMENT/AGREEMENT is executed and entered into for all purposes and in all
respects as of this ____ day of __________________, 2021 by and between:

KEVIN E. GASMEN, of legal age, Filipino, single and resident of and with postal address at Brgy.
Balbalayang, San Gabriel, La Union hereinafter referred to as the “FIRST PARTY”;
-AND-
DEXTER MARK C. APILADO, of legal age, sinle, and resident of and with postal address at BrgyPias,
San Fernando City, La Union, hereinafter referred to as the “SECOND PARTY”;
WITNESSETH:

WHEREAS, the FIRST AND SECOND PARTIES were involved in a vehicular traffic incident which
happened along Provincial Road, Brgy. Oaquin, San Juan, La Union as per attached Police Report bearing
Entry No. 2021-11-167 of the San Juan Police Station and made integral part hereof, on
____________________, wherein as a result of the incident, the BOTH PARTIES sustained minor injuries
and damages to both motorcycles ridden by the parties;

WHEREAS, the FIRST and the SECOND PARTIES agreed to settle amicably and as a consequence of
which, the SECOND PARTY releases the FIRST PARTY for any and all liabilities resulting from the
aforementioned accident;

IN WITNESS WHEREOF, the parties have signed this AMICABLE SETTLEMENT AGREEMENT on the
date shown at the beginning hereof in San Juan, La Union, Philippines.

CONFORME:
KEVIN E. GASMEN DEXTER MARK C. APILADO
First Party Second Party
_________________________ __________________________
(Competent Proof of Identity) (Competent Proof of Identity)

SIGNED IN THE PRESENCE OF:

_______________________________ ______________________________
(Competent Proof of Identity) (Competent Proof of Identity)

ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF LA UNION ) S.S.
MUNICIPALITY OF SAN JUAN )

BEFORE ME, a Notary Public for and in the Province of La Union appeared the parties with their
competent proof of identities stated below their signatures and printed names above.
Done this ___ day of ____________________, 2021 in San Juan, La Union, Philippines.

_____________________________
Notary Public

AMICABLE SETTLEMENT/AGREEMENT