 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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. Y- }1 v( r* e2 ~. ]CAR A:
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Plate Number:
2 i7 _" O$ c. t6 ^( J* WDriver Name: (called driver A in this document)
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4 g: v: D) B' T$ T/ _5 yCAR B:
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Maker/Model –, `# }9 r! [. _0 ?, S
Serial (VIN) # -
1 T- h j" l: d# NPlate Number:: f& O( `' X( f2 y6 ?4 B& Q' a( k& ]
Driver Name: (called driver B in this document)7 ~! [' L/ R. ^3 ~2 a; u( N
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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
A# t' ~. k; D* e! a1. Bumper repair: $
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) @! w; Y1 T: I4 Adriver 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.* ^% V5 b8 f2 i) O% j; h1 q
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Driver A:9 O7 `- l; s1 Z' e
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) |! S4 f5 L0 n9 t% B6 ^2 S) nDriver B:6 G3 `0 J2 B6 }! }& E0 p
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Signature Date:7 S# n9 S7 [' A! ?9 B; F1 J
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( {( S- M* A( @$ fWitness:$ K; U5 O& S6 | ]7 r5 k( k8 |, n) i7 Y
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Signature Date: |
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