 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。9 t3 ^3 T# u7 E. M4 _8 q3 k3 F
. s) k* [$ s' s2 {. Z, _6 `Settlement Disclosure% Q" t, ~1 D; X+ C2 `; ~
Final Settlement
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CAR A:
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Maker/Model -
0 k9 e6 G- [9 z! fSerial (VIN) # -
' U5 U4 d, q2 J; P6 N; V w$ xPlate Number:
" i1 S8 J) y# a( v+ X! c" LDriver Name: (called driver A in this document)
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3 b1 s; i$ K M; p! d8 CCAR B:! o, R1 W+ `+ E. N. X
Year - P3 d! _) v( ]( D4 M. b9 G
Maker/Model –' d" D' D9 o2 N0 w" p
Serial (VIN) # -
1 |, j- B( A6 ~" b1 N$ XPlate Number:
8 P# [) t; E6 m) N, _; \0 T6 ZDriver 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.8 e4 h% r4 z4 W* a
) i. S; N# C5 l2 L0 K, wThe driver B has paid3 s, m9 _+ R: d" k/ @
1. Bumper repair: $
; ^7 Z/ J6 ?/ k0 E2. Other Compensation: $+ q P7 U8 r; \8 \3 f
t4 A: x( b6 zdriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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% [; M0 e8 _, m9 b" D% LDriver A:
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$ _$ k% o7 C9 KSignature Date:
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Driver B:4 G) w4 Q' d$ n1 C- p5 f5 @, F% m
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Signature Date:
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0 D( z! B r2 {. o. eWitness:
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Signature Date: |
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