 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。% D, b, w* a1 n" B$ N l
+ Q3 G% ]& W: s6 tSettlement Disclosure
" j# i4 w) n& I! p8 w$ J( x0 f9 vFinal Settlement
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* \. {, W! \* ^CAR A:
1 K0 l, B/ ~+ N8 RYear -
7 }" z/ M/ q2 Q$ V, G. i3 vMaker/Model -
i) U& E" j. f+ d' V( F$ R! M& _Serial (VIN) # -
* g# u% ~8 i! ZPlate Number:
+ D( z8 S. @) k6 QDriver Name: (called driver A in this document)
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Year -
0 w1 |: s* b. tMaker/Model –6 R( L; v. g, |. A/ o
Serial (VIN) # -
3 g% D+ E: e2 J: Y( nPlate Number:5 \0 x, K* ?8 o2 j: E6 ?% Z* L
Driver Name: (called driver B in this document)
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" i% \ u8 R) h2 y h/ u: oIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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, c j& \6 |9 d# |$ gThe driver B has paid
( a! B! m0 }) y& h: W8 x1. Bumper repair: $
1 T2 v2 V4 E$ k" Q2. Other Compensation: $
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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.
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Driver A:: L/ h- b+ X( R; t# \* c9 I# H
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Signature Date:
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Driver B:1 j# M; U e8 I* D) Z
2 Z" p. T0 H. {2 L+ VSignature Date:
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Witness:+ W/ u- {; K+ L7 E- w# \/ F3 z+ F/ u
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Signature Date: |
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