 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
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CAR A:. T/ N0 L! R W8 s' |0 W4 J% o
Year -
W# S# |+ g: M; a7 b6 JMaker/Model -
2 n+ K# ?! s, V. P6 Y( Z0 I( GSerial (VIN) # -0 b4 y3 T6 @4 l4 o6 t, W
Plate Number:1 K: x- ~7 f, q5 \& V
Driver Name: (called driver A in this document)9 u' {; o. G" k/ X
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CAR B:
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6 K+ s- _$ a$ |5 i5 ~; d) xSerial (VIN) # -
( M1 V% J0 q0 n+ EPlate Number:
" v7 g! Z$ `* J9 _8 lDriver 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.
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! O: h% O- u: q+ N1 uThe driver B has paid* b$ M9 ^( k) f7 b" u5 e
1. Bumper repair: $% Y B8 Y5 R8 q1 f
2. Other Compensation: $- C' s; W, c. R- j8 G
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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# {2 F% d# q
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Signature Date:
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Driver B:
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Signature Date:
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Witness:
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Signature Date: |
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