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这里有一份
自己酌情改改就可以了。4 |, @# ~. k5 h q9 c* f
0 F, I1 s& A, [$ Z0 vSettlement Disclosure
# B& d. |" I: I t7 F3 S+ ]Final Settlement
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CAR A:, k/ M( |% r5 K8 V- N
Year -
- {% V, k Z- F& {3 YMaker/Model - H5 @4 S/ F& v, O. l
Serial (VIN) # -0 V4 ]/ P, T, N
Plate Number:
# U2 D) B5 `$ WDriver Name: (called driver A in this document)) |! Y: E$ m; n' C$ P1 A/ c4 b8 w2 |
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CAR B:
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$ }# M$ T0 e, \7 F3 G( x- ^3 JMaker/Model –8 z' E3 o) r3 z! p" l6 I
Serial (VIN) # -
! o/ X2 B- b7 Y8 y( |' z5 `2 iPlate Number:" e4 p7 v( _' X' s
Driver Name: (called driver B in this document)
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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: i5 ]3 O" U& P' [: |1 ^. NThe driver B has paid
# w( f7 z' V6 |! Y. N2 D& [! f1. Bumper repair: $
1 r, W0 ?8 v" m. ^" R. x2. Other Compensation: $7 K) V) G+ o* p' r5 F2 H! z
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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: h; {9 E& W0 MDriver A:' q# d& I( s0 G: L
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Signature Date:
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Driver B:
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Signature Date:1 J& S' Y! a$ V3 j! i# Q4 M- M
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. h3 w# T3 Y3 M cWitness:
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Signature Date: |
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