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这里有一份
自己酌情改改就可以了。& @( |9 j7 v4 d0 y) s
! A+ q) c' J/ V& C; XSettlement Disclosure- V3 `: W- Z8 N2 T t
Final Settlement
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CAR A:: F8 @- f" k$ U. V+ }) ~* m4 s$ ?
Year -
[1 g, ^9 S- L; NMaker/Model -7 ~! J) ~- {) w* S
Serial (VIN) # -
. I" w( J* U" Y' e2 L. EPlate Number:
0 U: Q5 u! t% M; bDriver Name: (called driver A in this document)
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CAR B:' {% Z6 s: f7 [& C5 E. M
Year -4 y. |6 ]" Y% o" }8 C
Maker/Model –9 M9 ~3 u* e) z" b! {+ `# T
Serial (VIN) # -
6 X& `, u! q6 n6 D- A% aPlate Number:" |& x) C7 _8 A% J- V
Driver Name: (called driver B in this document)8 r! I& X4 F5 n6 C
7 i6 N9 o# G/ G8 Q0 bIn the afternoon of Nov. 7th, 2007, car B hit the back of car A./ [9 e6 W) G( }% |- l
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The driver B has paid$ L& i+ H$ k* W
1. Bumper repair: $
5 _1 k2 Z! M- Q1 N- P4 ^2. Other Compensation: $. R" U( D Y$ `( _5 l
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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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! }6 h4 a2 G3 T! A/ V+ D4 @Signature Date:
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Driver B:
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Signature Date:
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: L& r4 N, e( i, ?* cWitness:2 l2 A( F3 ^% M/ I ]" J5 E
2 ]' I5 d8 X+ @& |* |' DSignature Date: |
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发表于 2008-3-11 09:16
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