 鲜花( 3)  鸡蛋( 0)
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这里有一份
自己酌情改改就可以了。/ [/ \- ~/ k- g0 |, U
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Settlement Disclosure
: H( I' Q) l* }- l9 p9 hFinal Settlement& a3 a" V' K, c" Y F, F
% C) `9 ] j& v& S0 Q+ ^/ t: O7 `CAR A:6 u& y& w( K/ l+ n Y
Year -# n3 `: l) X. z: c
Maker/Model -7 k5 a/ k6 b7 L- w- R% j! c. k
Serial (VIN) # -
7 X4 \) Y6 u6 ]$ \0 B1 `2 c; t3 BPlate Number:8 F" u7 y! a0 w
Driver Name: (called driver A in this document)
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. b# I$ z) _/ I/ _: ?CAR B:
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Maker/Model –0 A" a K% h$ `5 e
Serial (VIN) # -$ A$ F' O' ~" _5 d, K
Plate Number:. _6 M O% c1 S) Q/ Y) b9 x
Driver Name: (called driver B in this document)
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* C# \' K# }* C# X9 w( KIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.1 b6 J* e7 Q+ v/ M# a r
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The driver B has paid. L; _' @0 I2 M4 q: ~# e9 f
1. Bumper repair: $
3 y- W& a8 G }$ T. b0 s9 ]3 h2. Other Compensation: $
9 n0 I+ [0 C2 x% o" I, g* E: ?3 J( T3 \0 k8 ?
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.( Z5 N b8 Y4 D0 e; S
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Driver A:" R2 M. ]1 Q3 P$ L9 e
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Signature Date:
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2 h; M1 }; A( ~: M( ^Driver B:* X) i. ?' S, ^5 m# p' i* Z
+ q4 y' T5 B/ m- z4 L7 ]Signature Date:# n3 y5 Z/ C3 z) N9 d
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Witness:
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Signature Date: |
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