 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。; @9 q/ i4 m* W. b6 T( I7 _; r) q+ D
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Settlement Disclosure
7 d% j, M* J( H5 G* UFinal Settlement
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CAR A:
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Maker/Model -
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# Z' s; M! X+ L M! IPlate Number:
( S# X/ W' a/ SDriver Name: (called driver A in this document)" e+ r; Q0 @( [& m( B" u
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Year -
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7 q8 c) x; W( X$ U) QSerial (VIN) # -$ K7 x- n6 l( c* m/ U7 ~7 \
Plate Number:# J, M3 b) P' _* o- q2 f( z# d
Driver Name: (called driver B in this document)- a+ {. D1 n$ I. Y5 O# e
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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' p; I- d% D) l: ?8 [; `The driver B has paid
# R& p* h6 z& ^+ Q6 r9 ~1. Bumper repair: $& q6 m; x0 s' M: H1 H9 T% m
2. Other Compensation: $ F1 o% \& h6 v4 K7 K5 |
- J6 O& `. `0 s# f; o1 ydriver 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:. L" e, a& p! C) }0 Q' U. o
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Driver B:' @$ i, B& n7 V- ~7 h. Z6 A
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Signature Date:/ D: [, w' z9 a0 |6 p
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' P$ C, X- e! w0 BWitness:: S2 p# M% f& w; T. i. v6 ^0 }
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Signature Date: |
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