SUBSCRIBE AND SWORN TO Before Me This - at Dipolog City, Philippines

This document summarizes an amicable settlement between Pederico Sacumi Agustin and Jemar Abdulla Lawan regarding a vehicular accident. The accident occurred on February 15, 2019 when Lawan, driving a vehicle owned by Abdulgani Said, accidentally bumped into Agustin along a highway in Dipolog City. Agustin sustained minor injuries and was treated at a local hospital. Both parties agreed to settle the matter amicably without legal action in order to preserve friendship and harmony, with Lawan assuming financial responsibility for Agustin's medical expenses.

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SUBSCRIBE AND SWORN TO Before Me This - at Dipolog City, Philippines

Uploaded by

Jubelee Anne Patangan

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AMICABLE SETTLEMENT

KNOW ALL MEN BY THESE PRESENTS:

This AMICABLE SETTLEMEN entered into and executed on this ________ day of 2019, at
Dipolog City, Philippines by and between PEDERICO SACUMI AGUSTIN of legal age, Filipino,
married and a resident of Sta. Filomena, Dipolog City, herein referred to as the First Party and JEMAR
ABDULLA LAWAN, of legal age, filipno, married and a resident of Zamboanga City, herein reffered as
the second party;

WITNESSETH

1. That sometime on February 15, 2019 at about nine twenty pm. (9:20 pm) more or less, a
vehicular accident transpired along National Highway of Sta. Filomena, Dipolog City, wherein
one Pederico Sacumi Agustin, herein referred to as the first party was accidentally bumped by a
four wheel vehicle KIA registered under the name of ABDULGANI SAID, a resident of Tituan,
Zamboanga City but driven by JEMAR ABDULLA LAWAN, herein referred as the second
party hitttig the first party crossing the road from left side of the road to other side of road facing
North direction (from Galas to Sta. Filomena). As a result of the accident,the first party was
lifted and brought to ZANORTE MEDICAL HOSPITAL by ambulance for medication. As
diagnosed by Dr. Lim, the first party sustained only minor injuries and expected to be released
on February 18, 2019;
2. As disclosed, the incident (see Certification issued by PO1 Neil Enon, Traffic Investigator)
dated February 17, 2019 was pure accident;
3. That considering that the incident was pure accidental and not intentional, the parties concerned
for the sake of friendship, peace and to preserve harmony and it was not a serious one, decided
to settle the above incident with the second party assuming all medical and incidental expenses
as well as professional fees thereof;
4. That the first party for his part hereby renounces, waives and desists not to pursue any civil or
criminal action that may arise from the incident against the second party.

IN WITNESS WHEREOF, I have hereunto affixed my hand this __________day of February,

2019, at the City of Dipolog, Philippines.

PEDERICO SACUMI AGUSTIN JEMAR ABDULLA LAWAN,

First Party Second Party