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这里有一份
自己酌情改改就可以了。9 Q, U: y7 r$ Q& |" W- c" u, _
. t1 L5 S% u7 C2 ]* H0 G8 DSettlement Disclosure. N5 _- d" U( j. f1 E
Final Settlement
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CAR A:
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Maker/Model -
: o0 ~ c* Q: c NSerial (VIN) # -
[. Q6 s) n R4 y+ b. TPlate Number:
+ A6 F2 t. W$ d5 x/ [- MDriver Name: (called driver A in this document)
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$ m* @- z2 l6 T, h% JCAR B:1 A8 b5 }7 h9 X* d. p* m" W
Year -4 R& ^ {8 z0 x) w+ J; [5 n3 N# d
Maker/Model –
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Plate Number:
, b; E5 \% t- UDriver 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.* p9 |: n0 M/ ^2 l- i
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The driver B has paid% U( A# V, w1 [$ O* e
1. Bumper repair: $, [$ O, L X( f, U
2. 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:4 U& `0 \% k" _
3 |. l1 Y8 Y1 M% zSignature Date:2 f# \$ L, F6 [$ j
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Driver B:
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Signature Date:: u" f/ H" y( X: }* B3 [
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Witness:9 {6 R! M! }: Y4 m" r+ s
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Signature Date: |
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