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这里有一份
自己酌情改改就可以了。8 P8 z7 l: H' S& Q- @: }
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Settlement Disclosure4 |7 ~: A( C, m' g G
Final Settlement* F* N0 d# l& L; Z
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CAR A:3 Q8 w7 J) |6 e( M" _3 F7 ?: o$ f5 r0 u
Year -
p4 U7 ~& j! Q, ~) \! DMaker/Model -
" C5 |0 z* e+ K* LSerial (VIN) # -' t" ?. d, e& B
Plate Number:
c1 ^; G1 R- f3 w9 GDriver Name: (called driver A in this document)
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CAR B:& F' L- V* g" W' L5 _ W
Year -
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Serial (VIN) # -6 _4 |" F' K4 R! K+ m+ v2 n
Plate Number:! j' }% \2 E7 P; U, k
Driver Name: (called driver B in this document)5 U5 r- ?# L4 z$ F
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.6 _0 ~2 X# B$ _% S8 u. }
# s' Y% E6 P/ E% G; jThe driver B has paid1 s7 ~- c7 l D# j) a
1. Bumper repair: $& t1 V$ b, O! F `( [ Y
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.+ b3 }3 J+ K: H3 t; h
% F/ ^6 g6 a Y& `% |, H) cDriver A:
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Signature Date:
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Driver B:
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Signature Date:2 G" U( V: v/ X+ R' r R
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& H# [' R |: ^- `; Q( JWitness:
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9 f5 I; v& m/ Q4 HSignature Date: |
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发表于 2008-3-11 09:16
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