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Claims Release Form
Settle disputes and release liability with this Claims Release Form template.
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Claims Release Form Template
This Claims Release Form (“Release”) is entered into on [Date], by and between:
Releasor: [Full Legal Name, Address] and
Releasee: [Full Legal Name, Address] (together, the “Parties”).
1. Background
The Releasor asserts or may assert claims against the Releasee arising from or relating to [describe incident/transaction/dispute] occurring on or about [Date] at [Location]. The Parties desire to fully and finally resolve all matters between them without admission of liability.
2. Consideration and Payment
In consideration of this Release, the Releasee shall pay the Releasor the total sum of [Amount] in [lump sum/installments], payable by [payment method] on or before [payment date(s)].
If any installment is not timely paid, the unpaid balance shall become immediately due, and the Releasor may seek entry of judgment for the unpaid amount consistent with applicable law.
3. Scope of Release
The Releasor releases, acquits, and forever discharges the Releasee and its past and present parents, subsidiaries, affiliates, insurers, reinsurers, officers, directors, employees, agents, successors, and assigns from any and all claims, demands, causes of action, damages, costs, and liabilities of every kind, whether known or unknown, suspected or unsuspected, arising out of or relating to the matters described in Section 1.
4. Unknown Claims; Section 1542 Waiver (if applicable)
The Releasor understands that this Release covers claims that are known and unknown at the time of execution. If governed by California law, the Releasor expressly waives the protections of California Civil Code §1542 (or any similar law), acknowledging they may hereafter discover claims or facts different from or in addition to those now known or believed to be true, but nevertheless intends to fully and finally settle and release all such matters.
5. No Admission of Liability
This Release is a compromise of disputed claims. The Releasee denies liability, and nothing in this Release shall be construed as an admission of fault, liability, or wrongdoing.
6. Indemnification for Liens and Third-Party Claims
The Releasor is responsible for satisfying any liens, subrogation interests, or assignments related to the released claims, including but not limited to medical, governmental, or insurer liens. The Releasor agrees to indemnify and hold the Releasee harmless from any such claims asserted after payment of the consideration.
7. Taxes and Allocation
The Releasor is solely responsible for any taxes arising from the consideration paid under this Release. The Parties do not provide tax advice and recommend consultation with a tax advisor. If the Parties intend an allocation (e.g., to wages, emotional distress, or physical injury), specify: [allocation terms].
8. Confidentiality (optional)
Except as required by law, court order, or to professional advisors, the Parties shall keep the terms and amount of this Release confidential. A breach of confidentiality may entitle the non-breaching Party to appropriate relief, including injunctive relief.
9. Non-Disparagement (optional)
The Parties agree not to make false or materially misleading statements about each other concerning the released matters. This provision does not restrict truthful statements required by law.
10. Representations and Warranties
The Releasor represents that:
a) They are the sole owner of the released claims and have not assigned or transferred any interest in them.
b) They have read this Release, understand its terms, and sign it voluntarily without coercion.
c) They have had the opportunity to consult independent legal counsel.
11. Mutual Cooperation and Further Assurances
The Parties shall execute any additional documents reasonably necessary to effectuate the purposes of this Release, including lien confirmations or dismissals of pending actions related to the released claims.
12. Pending Actions and Dismissal
If a lawsuit or administrative complaint is pending regarding the released matters, the Releasor shall file a dismissal with prejudice within [X] days of receiving the consideration, with each Party bearing its own fees and costs unless otherwise stated.
13. Attorney’s Fees and Costs
Each Party shall bear its own attorney’s fees and costs incurred in connection with the released matters and this Release, except as provided in Section 12 or as otherwise expressly agreed in writing.
14. Breach and Remedies
In the event of a material breach of this Release, the non-breaching Party may seek all remedies available at law or in equity. The Parties acknowledge that monetary damages may be inadequate for a breach of Sections 8 or 9, and injunctive relief may be appropriate.
15. Severability
If any provision of this Release is found invalid or unenforceable, the remaining provisions shall remain in full force and effect and be construed to effectuate the Parties’ intent.
16. Entire Agreement; No Reliance
This Release constitutes the entire agreement between the Parties regarding the subject matter and supersedes all prior or contemporaneous communications. The Parties do not rely on any statements or representations not expressly contained in this Release.
17. Amendments and Waivers
Any amendment or waiver must be in a written document signed by both Parties. No waiver of any breach shall be deemed a waiver of any subsequent breach.
18. Governing Law and Venue
This Release shall be governed by the laws of [State/Country]. Any dispute arising under or relating to this Release shall be brought in the courts located in [County/State], unless otherwise required by law.
19. Counterparts; Electronic Signatures
This Release may be executed in counterparts, each of which is deemed an original, and together they constitute one instrument. Signatures transmitted electronically or by digital platform shall be deemed originals and enforceable.
20. Capacity and Authority
Each signer represents that they have legal capacity and authority to execute this Release on behalf of themselves and, if applicable, on behalf of the entity they represent.
21. Effective Date
This Release becomes effective on the date it is signed by the last Party to sign, unless otherwise specified in Section 2.
22. Signatures
Releasor: _______________________________
Printed Name: ___________________________
Date: __________________________________
Releasee: _______________________________
Printed Name: ___________________________
Date: __________________________________
Witness/Notary (if required): ___________________________
Commission Expires: _________________________________
Details
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Claims Release Form
CLAIMS RELEASE FORM FAQ
What is a Claims Release Form?
A Claims Release Form is a settlement document in which one party (the releasor) agrees to waive current and potential claims against another party (the releasee), usually in exchange for payment or another benefit. Once signed and effective, it provides finality and prevents future lawsuits over the released matters.
Why is a Claims Release Form important?
It creates a clear, written record that the dispute has been resolved and that no further claims will be brought. This protects both sides: the releasee gains certainty and closure, and the releasor receives agreed consideration without ongoing litigation risk or expense.
When should you use a Claims Release Form?
Use it whenever parties resolve a dispute—such as an accident, property damage, contract disagreement, or employment issue—and want a binding, enforceable settlement. It’s commonly executed at the time of payment or immediately after terms are finalized.
What should a Claims Release Form include?
It should identify the parties, describe the dispute or incident, state the consideration being paid, and clearly define the scope of the release (including whether unknown claims are covered). Many releases also address liens, tax responsibility, confidentiality or non-disparagement (if desired), and governing law.
Is the release mutual, and can it cover unknown claims?
It can be one-way or mutual. If both sides want closure, a mutual release is appropriate. Some jurisdictions allow waivers of unknown claims (e.g., California’s §1542 waiver), but this must be stated expressly—use only if both parties understand its effect.
Do I need notarization or witnesses?
Notarization isn’t always required but can help with enforceability and record-keeping, especially for larger settlements or where state law or an insurer requests it. When in doubt, add a notary block or follow the counterparty’s formalities.
Are there tax or lien considerations?
Settlement proceeds may have tax implications depending on the nature of the claim. Healthcare, governmental, or insurer liens may also apply. Address these in the release and consider getting tax or legal advice before signing.
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