 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
- [1 a! Y" ]. {Final Settlement* B5 R4 X3 o$ X) k( ]& [
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CAR A:
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5 e) P0 s0 i% O9 S! g' |, B4 n6 LMaker/Model -
/ x1 d. z' m, f& w! P9 @Serial (VIN) # -+ ^1 p' \$ H7 z- W6 C5 w' h
Plate Number: K) l- H8 i) e4 \
Driver Name: (called driver A in this document)# J$ x, `" ]" P7 ^7 X% G
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CAR B:/ T2 ]6 s& w& M! |" |
Year -' d" \. q& P( h- k3 V& `! S6 u# I( A0 E
Maker/Model –
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1 {0 B6 j* U$ A& QPlate Number:
. w0 M# d8 u3 k' l& Y) lDriver Name: (called driver B in this document)6 H7 W/ W- i/ B
9 R, C5 ~5 [( `+ kIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.# U( a: D u: T" h2 w1 Q
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The driver B has paid
% B' Q, X c) x" Y9 ~1. Bumper repair: $: F& q- A& O9 B8 x* q4 u- Z
2. Other Compensation: $
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) ~- r# a5 `% {3 q8 O! m( S2 A: ydriver 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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& S4 X# `0 [( S7 o; b: h- S' rDriver A:
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2 B4 G7 w4 A) t1 u7 V# `Signature Date:
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Driver B:
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Signature Date:- B2 x5 W: R9 w) A: L `
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Witness:
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Signature Date: |
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