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这里有一份
自己酌情改改就可以了。7 r9 {2 U, P- @) o: f R
9 x% E0 r2 E. k6 l4 ISettlement Disclosure
9 V1 f! h( T& R& ~. {Final Settlement
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Year -
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Driver Name: (called driver A in this document)
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: O& [4 i4 w" j' H* JCAR B:
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Serial (VIN) # -
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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.6 ^0 [9 T( r8 b" b" d9 J" J
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The driver B has paid `1 ^7 i& ]! o3 [/ U
1. Bumper repair: $! O9 h; X9 a) Q4 V+ R# v. x
2. Other Compensation: $
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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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Driver A:
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Signature Date:
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Driver B:
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Signature Date:- R- Q# ~! V4 ^
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, u# N- K& w$ J; S. ~/ j' ]Witness:
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Signature Date: |
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