 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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! o) e( G( F4 y: C" z/ eSettlement Disclosure
- ~) w# E+ | f6 V3 G# uFinal Settlement
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, e4 k' S9 a M+ M! sCAR A:
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8 w( D7 j. ^$ i& s; VMaker/Model -
5 m8 z" M8 \0 q0 z) N" pSerial (VIN) # -! e f4 n- s" U. H7 h
Plate Number: F1 e5 v. ~9 E0 C
Driver Name: (called driver A in this document)$ k* f1 n9 @. ~) `
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CAR B:
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' \2 Q' y- ~0 l) i$ H" Q7 rPlate Number:1 Q6 E8 v( C5 p
Driver Name: (called driver B in this document)! m0 p( M8 f) m
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In the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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The driver B has paid
7 L2 X" g/ _5 U$ [1. Bumper repair: $
+ H) p9 U& [8 D* _7 [ b2. 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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4 _* c+ h) R# y) I% v) uDriver A:
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( a; y, h' q. M V; WSignature Date:5 B3 G: C4 z* H. y- _
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Driver B:
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Signature Date:. W+ [4 ^# |! g# s# _3 c. m) N! S
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8 z" K6 T$ G8 u p1 j' DWitness:
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% P& t" h- G1 }, k0 C- G$ s5 ?Signature Date: |
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