 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- Y% p! h2 \# s
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Settlement Disclosure
" T7 {" ^- O, j4 i5 b# G0 r( TFinal Settlement
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7 G+ ?9 d Z! F5 W; {; O6 l. N2 _CAR A:1 d, }" k v% @" e8 `
Year -4 } L9 U# k, n/ O- g. {9 H
Maker/Model -* E# T4 B) X" ?8 o% E
Serial (VIN) # -
" U# O! x' y# N1 IPlate Number:5 J# m* J E6 e/ [# a
Driver Name: (called driver A in this document)- v0 v n7 i6 d5 Z+ u. |! U
. o% @9 E0 ?+ B Z# [CAR B:
& U7 z! ], C0 c$ vYear -
; l5 M. C; G' G! B& k' [Maker/Model –
( U4 L; w3 b; A6 E$ G9 f+ jSerial (VIN) # -2 Q9 _7 I! J2 I; N3 Z
Plate Number:
9 {1 _% J0 p: j- P2 s) U% HDriver Name: (called driver B in this document)4 {: K5 F1 U1 [; c. z2 H
* `/ l( e6 B* r* X4 V: p* w/ x! BIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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- d! S& }+ H' v- k3 {4 sThe driver B has paid
4 y& F' d0 S- o5 G/ Q8 S1. Bumper repair: $
# ~* x9 {5 b N4 P3 w2. Other Compensation: $7 N! [9 U5 S' C$ Q
8 o2 j0 c' h$ rdriver 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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( f0 f) C6 y) C: x) i W5 KDriver A:7 z D9 k9 ?( K" s% M4 ^# x
! U/ A! v' h; M) cSignature Date:1 Q- R. t, T5 r7 y f& Q
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Driver B:
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Signature Date:' i' r7 d A0 R0 q6 ?7 `0 ^$ Y" U
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! e8 M, ~; Y1 i- ]Witness:
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* B' _# ^! J5 s' GSignature Date: |
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