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FOR AND IN CONSIDERATION of the payment of the sum of $ ####.00 ( #### THOUSAND #### HUNDRED ####AND 00/100 DOLLARS), upon signing this Release, I, the undersigned, hereby release and discharge AAAA, BBBB Company (including all its subsidiary/member companies) from causes of actions, on account of, or related to, claims for property damages resulting from an occurrence taking place on #####, XXX, as more fully described in the Warrant in Debt and Bill of Particulars filed in the FFFF General District Court, Case No.:  ###### except that AAAA, BBBB Company (including all its subsidiary/member companies) report my vehicle as salvage to the FFFFF. Specifically, I acknowledge that this entire agreement will be null and void should AAAA, BBBB Company (including all its subsidiary/member companies) report my vehicle as salvage to the FFFFF and I further acknowledge that if it is determined that my vehicle is reported to the FFFF as salvage then my right to sue AAAA, BBBB Company (including all its subsidiary/member companies) for property related damages will be restored.

I understand that this release applies only to the property damages alleged from ####, 2022 occurrence and does not impact my present and future claims to other damages related to this occurrence.

I hereby declare and represent that in making this Release and Settlement of Claim, I understand and agree this Release and Settlement of Claim is entered into voluntarily, and I rely on my own choosing and fully understand the impact of my actions.

I understand this settlement is a compromise of a disputed claim.

I declare and represent that no promise, inducement or agreement not herein expressed has been made to me; that this Release and Settlement of Claim contains the entire agreement between the parties hereto; and, that the terms of Release and Settlement of Claim are contractual and not a mere recital.  I also agree that the terms of this document are to be construed under the laws of the FFFF.

In the event AAAA, BBBB Company do not comply with the settlement terms of this document, then I have the leave and right to do whatever is legally necessary to enforce the terms herein and obtain the above-mentioned settlement.

I further state I have carefully read this final Release and Settlement of Claim, consisting of two (2) typewritten pages, I know the contents thereof, and have signed the same as our own free and voluntary act this _____ day of ___________, XXX.

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