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这里有一份
自己酌情改改就可以了。3 A" X9 P1 y# e- e4 Z
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Settlement Disclosure5 w+ ^) D: i3 v! M- R4 T8 I% i
Final Settlement
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CAR A:, W+ _, @& I) h1 e" R3 z
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Maker/Model -
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Plate Number:
) w' ]4 H5 ?9 i6 `2 P7 a) v0 HDriver Name: (called driver A in this document)' S, s4 o+ t( O% a3 r
1 O2 f5 _+ H4 i+ I) |# c* RCAR B:
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Plate Number:
T" c- `5 ]3 r* [Driver Name: (called driver B in this document)2 [* H! Z3 ~9 `0 ^: T
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
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2 O) E9 a4 _9 M5 Z3 G; j2. Other Compensation: $
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# ~: ]3 M, M; [( ~; h4 n# ~$ N) Jdriver 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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, @. v [( B6 e7 T/ rDriver A:
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$ q9 \; F$ D$ n P1 RSignature Date:! f9 i7 k/ Z k; Y: L" k7 \& o
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Signature Date:
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/ r2 B0 A- @, cWitness:$ N" a" w) O, E
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Signature Date: |
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