 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。$ c4 f& q5 J( J7 u' ^
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Settlement Disclosure
' |4 X! _/ z/ pFinal Settlement
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. Q ~0 T! ]2 _, bCAR A: e8 E# e/ n# g2 K. o
Year -# H& c( Z$ W( j( m; `- [ O
Maker/Model -
3 }/ \4 l4 p! u$ E4 xSerial (VIN) # -
5 A4 I1 k/ m% Z0 FPlate Number:
/ [) x9 l; Y+ {+ w% W& V0 X7 `Driver Name: (called driver A in this document); _+ X- F ~# k5 O* l# p; d
5 o6 o$ s- j9 J2 w _CAR B:$ V8 E* P( a1 J2 J7 y9 X
Year -
/ ?9 W) b$ G# @8 YMaker/Model –
* A0 N2 ?$ e9 \; _$ b3 f7 RSerial (VIN) # -
- N5 T: a0 y$ s) @+ ?" rPlate Number:# ^7 t+ Q) F4 t0 w
Driver Name: (called driver B in this document)+ W4 C& u7 T6 s/ e% M C
7 i/ |: ]. |* s6 A# jIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.9 {. d. j, e/ U m
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The driver B has paid
1 G& q2 R7 W$ _& Z3 \' H1. Bumper repair: $
) [ B: n9 q9 ]$ F* R* U( 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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2 k* j# N) Q* y9 X, c7 ~3 K. ODriver A:
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Signature Date:
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( M; \2 U2 m5 y8 s/ C; YDriver B:6 C. x; C- g3 k& e) i" h4 G3 M+ _" b5 e! N
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Signature Date:
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Witness:% l9 Q, }# n% D. F% p
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Signature Date: |
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