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这里有一份
自己酌情改改就可以了。8 b4 f8 c' T0 Y s5 x
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Settlement Disclosure
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4 a2 I+ E" c0 E+ u7 VCAR A:; F8 T/ v& ]2 w/ l5 M* r
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Maker/Model -4 B @ A& i# A; z3 `8 i1 a" @
Serial (VIN) # -
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Driver Name: (called driver A in this document)
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6 C& L' f" V6 o8 @' X1 F! |4 K& aCAR B:
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Serial (VIN) # -& i- b" m+ {4 v. r8 {0 h3 c. x% Z
Plate Number:) j1 g. Z0 m0 V) v+ x
Driver Name: (called driver B in this document)8 c2 _( y. o+ y# b! H; D
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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$ _4 c5 u: i# i; F$ N3 DThe driver B has paid2 U }* q K* H9 y
1. Bumper repair: $
: ]/ M& h0 M c( {( |+ m2. 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:
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Signature Date:
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4 w; E& g9 H! TDriver B:
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Signature Date:
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Witness:
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Signature Date: |
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