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这里有一份
自己酌情改改就可以了。5 E" R6 j8 X, Q6 _- b
1 P$ {4 c$ F$ T# q5 K6 BSettlement Disclosure
% i1 f b" i0 Z% mFinal Settlement1 ]* [9 ^: G3 g2 c; c7 S
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CAR A:3 U8 \& }# |' l! ?/ I
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Maker/Model -1 s2 @$ F- h# y
Serial (VIN) # -+ Y9 E$ X6 G4 K: F; y5 T
Plate Number:; ]+ K: ~: w( b+ M+ u. L3 j" s
Driver Name: (called driver A in this document)
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CAR B:
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Maker/Model –% d! R+ T% ~& R! a( E9 d2 ~) ?8 w/ R
Serial (VIN) # -
& j4 R# V/ \/ Q$ qPlate Number:* x$ X( G' y) S
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 paid
. k1 {. E, p5 `- ^ s1. Bumper repair: $5 K( ]7 @* v% G; p) l0 M( Y
2. Other Compensation: $
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9 a3 @8 I. I. N) \4 Y$ _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.9 l, { y; S- t. s3 a
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Driver A: `1 K! w/ C' ^
* a8 S9 z% ?0 i2 E5 }Signature Date:
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Driver B:3 j/ ~; o h C7 C5 h% C! t
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Signature Date:
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; N, I- J. Z" `" X; i; c, y1 E; d3 nWitness:
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Signature Date: |
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