 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。! T5 i& z+ D$ W; P0 F4 d
7 w' v( |/ m+ `3 U6 @Settlement Disclosure
* E7 a$ I) V9 FFinal Settlement1 c. L+ y) A' d' J
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CAR A:
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Serial (VIN) # -+ ~8 a* X/ S5 [8 L& l2 b- A9 @
Plate Number:
2 ~0 J. c1 f- k4 s8 I% ~+ L0 sDriver Name: (called driver A in this document)
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( x4 T6 a7 K( g4 jCAR B:
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Maker/Model –
: y/ G$ Y4 w- k- K9 F% |Serial (VIN) # -
, o( |1 ]: m4 c0 {3 u1 BPlate Number:
0 ?" |) I. Z8 }& oDriver 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$ U" m. w& @ M
1. Bumper repair: $
3 ~: i1 L7 J! C& z2. 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:) Z6 P8 i2 m' s
( p7 W- k7 A1 o# y5 ]Signature Date:
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' S) E: ]/ u" Z6 `7 NDriver B:- X8 C( E$ h+ E E3 S+ o/ q& {
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Signature Date:6 z: D" s* {7 T3 l4 T7 E
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Witness:# i8 k+ f' ~, M! e6 @
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Signature Date: |
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