 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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; M" v% w" X) e! O" N2 e6 E/ e# `5 QSettlement Disclosure2 i! b R R: q l
Final Settlement
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CAR A:, s% x" ?0 }9 ~+ h
Year -
5 D; Z. x# m; Y' e5 eMaker/Model -9 P& p- ^4 [6 R- V3 |6 [* J1 u4 p
Serial (VIN) # -
1 B3 N" w% p, G' b' y PPlate Number:
3 k1 U3 U8 c5 K4 T+ K3 i/ m" w1 y% EDriver Name: (called driver A in this document)
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CAR B:
* _$ d( b( ?$ e+ q Z9 w4 x% eYear -
, u5 @( R5 S* \$ i2 X) {8 XMaker/Model –
+ j2 Q0 l: z9 W9 i+ `+ ]; j, QSerial (VIN) # -7 t* k" F: b, J7 p: I
Plate Number:
5 j* B, @0 u: x% G& NDriver Name: (called driver B in this document)1 m" L' F/ }/ G, s- V% ^9 B
6 V" h+ V/ b" b+ ^4 h/ E" r4 qIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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( V# W4 E+ e0 u! BThe driver B has paid
: `% L, Q3 u# h" o2 @+ Z6 [2 o1. Bumper repair: $
1 p/ B1 p+ l, o: p+ a% {8 F9 O2. Other Compensation: $! S4 h* r! k2 m( m9 `
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driver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.
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& T' H0 ]! q* L% B, [Driver A:& H' s1 J7 v' \ d
! D+ J; e5 s8 i) X b: S( oSignature Date:
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Driver B:, b1 k& \! W; s% f2 J. `2 e, e
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Signature Date:2 X' S' D+ s4 V' K7 r
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+ n$ b( }# J8 P T- RWitness: Q, B8 p# ]/ U) {4 ~
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Signature Date: |
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