 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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Settlement Disclosure
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: k }, E5 b8 Z) P7 z% I& }CAR A:' i! ^+ s4 X- d
Year -
6 O8 w: t/ E( I: [7 Y8 g+ ]Maker/Model -
5 \ q% e% T3 t: V3 o; ^- bSerial (VIN) # - L8 ?8 U' I. K9 x/ W" k
Plate Number:7 K! }; u5 h3 B1 G9 z
Driver Name: (called driver A in this document)
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CAR B:7 c! Z6 _+ n0 M' D2 o6 z0 W) C* f9 ]7 D
Year -2 G; W! l7 I5 C
Maker/Model –
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Plate Number:* @2 D" I& D W5 U" Q: a5 D) D$ [
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.$ U3 R0 z; q( k) |. C) O7 }/ W: n
* Y( r& F3 O: ?The driver B has paid
# x) I1 B4 Q& B( D' Z$ I3 p1. Bumper repair: $
, Q% Q" m% |" O2. Other Compensation: $
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( F& y! |. o* `- s) \: h# jdriver 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.1 A, ^ ?" I/ `* }" B1 }- g$ g$ D
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Signature Date:
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Driver B:
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Signature Date:
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Witness:
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Signature Date: |
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