Settlement Disclosure
Final Settlement
CAR A:
Year -
Maker/Model -
Serial (VIN) # -
Plate Number:
Driver Name: (called driver A in this document)
CAR B:
Year -
Maker/Model –
Serial (VIN) # -
Plate Number:
Driver Name: (called driver B in this document)
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
The driver B has paid
1. Bumper repair: $
2. Other Compensation: $
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.
Driver A:
Signature Date:
Driver B:
Signature Date:
Witness:
Signature Date:
Final Settlement
CAR A:
Year -
Maker/Model -
Serial (VIN) # -
Plate Number:
Driver Name: (called driver A in this document)
CAR B:
Year -
Maker/Model –
Serial (VIN) # -
Plate Number:
Driver Name: (called driver B in this document)
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
The driver B has paid
1. Bumper repair: $
2. Other Compensation: $
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.
Driver A:
Signature Date:
Driver B:
Signature Date:
Witness:
Signature Date: