 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。
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* ^* E( g V0 ?Settlement Disclosure6 k8 G. N. g5 F% ~* L" R
Final Settlement7 P) d& Q2 X Z6 Z# u( }
* I( s( Z9 y3 [9 {! R: s4 yCAR A:
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Maker/Model -
6 q! z# j7 v( C2 |% q5 YSerial (VIN) # -
1 z& I- Q( [4 Y$ k/ LPlate Number:- y* e) @8 ]8 [7 w; J* v
Driver Name: (called driver A in this document)
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4 A, J' y2 v K$ ]# Z9 w" ]5 X, ICAR B:) w' y7 G. J& m% _
Year -
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+ M" B3 x+ e. }, E" KSerial (VIN) # -
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Driver Name: (called driver B in this document)% I9 h: O4 E+ N6 l& f; L
7 N6 E+ L3 j; f/ a# O3 y9 cIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.) v6 g" J1 Z' I+ G$ I# u+ t
- Q/ @4 s& L5 a- u h0 FThe driver B has paid5 x/ V V6 B* w
1. Bumper repair: $) c& b" c4 {% n. d* ]& Y
2. Other Compensation: $
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4 k: j4 W- B1 U7 B( g0 Xdriver 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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- I0 T1 g% a# Z" tDriver A:3 ~, s. i" z4 l2 A; Q' `9 x4 `/ B
5 ^! e6 b( w$ L; g, YSignature Date:6 o4 J' x( }3 B, o
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Driver B:
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$ Q9 h/ M/ B- |. a4 O: O7 r8 sSignature Date:: P! C6 k% f* N( N& m1 w" x
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Witness:; V! H3 i, q K8 d
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Signature Date: |
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