 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。& x+ d0 c- n* K9 M, ~
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Settlement Disclosure
4 f' i3 r3 L$ X4 |* `6 |# GFinal Settlement6 G8 {5 N( l% a: B W) k: _
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CAR A:& p8 N8 b! ]: _: k' j
Year -/ D- T. j- k) O8 Y8 l
Maker/Model -4 w4 o& I4 g" o; ~4 O& F4 i" V3 j
Serial (VIN) # -& ]. U. m9 [" r
Plate Number:! U7 D4 R% ~6 w' ^" z1 K
Driver Name: (called driver A in this document)* D1 Z9 }+ a/ w! q% X: f
% ^' p& V2 l! S9 h: W& B0 {4 C) JCAR B:
8 x! z" H6 e! v7 `* P) ]: W5 RYear -
4 j7 d# a7 Q6 |+ s8 d8 J" S$ `- XMaker/Model –+ z3 X5 {8 V1 a1 e. X
Serial (VIN) # -
( W% U4 F: R) o$ CPlate Number:
5 R* X# T7 F7 d1 `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.
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The driver B has paid8 {7 E! W4 \! v, A/ I% O- [/ H; y: f% I
1. Bumper repair: $& ^) W# X, x+ v
2. Other Compensation: $
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7 ~8 a( N4 z! `3 V) Ddriver 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./ C6 @, y2 Q" {
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Driver A:7 F6 p+ ]# n4 V' r: Y
7 S1 \+ Y2 i, S+ G) _ a- MSignature Date:6 ~/ l* L2 _! c# v
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5 `( [" l4 y& CDriver B: y* M8 S8 @8 K; L0 c* D* m* @5 h
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Signature Date:% P$ Q2 P2 A( p" E5 C/ ] _
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" Y4 R+ h4 V! @( Z$ |Witness:9 F. G, I1 {& n9 Y l5 `9 H5 L+ k
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Signature Date: |
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