 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。4 [, ^: f2 f; P9 T0 ^# C; E( l7 D
& X8 O- q( s% C( ?9 W9 XSettlement Disclosure* U8 h) M( \' x9 J( h" l2 l, S0 t$ I
Final Settlement
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CAR A:, P% e9 [) k6 F# n
Year -& V# t1 [! a! }$ O9 ]) L, Y
Maker/Model -
; {+ `! x: Q! Y9 |4 [, A% i% ASerial (VIN) # -
% n! b2 t% J! \1 h# \% h2 }Plate Number:
# c3 O, R# G* r. X& o. ]$ R! _$ ]3 tDriver Name: (called driver A in this document)7 q- {5 X9 ~% g5 O# o+ I. y
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CAR B:
& p t8 P' g5 i8 Q0 P: BYear -& b9 ~; P7 d4 H( r4 d- N! C
Maker/Model –
3 G# u( {1 F1 R7 |7 o+ YSerial (VIN) # -; u# {( P# r, A- W4 Z! w- {" u
Plate Number:" ]1 t/ G: J9 z" }9 v' y
Driver 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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) h. N( X( R$ v5 e! W5 c: rThe driver B has paid# `1 ^# `; R) \
1. Bumper repair: $5 W; w( T' @( [1 @- v+ d
2. Other Compensation: $" Z7 Q7 _ P, ~& L) g$ U9 o8 Q7 b
5 Y& N" E$ ]# X$ {1 f$ Ydriver 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./ U( W( ?" G& j& l
4 [4 f. i9 t- }) o kDriver A:; c8 y5 u. V3 O- U" E
) u w, q- Y( a% U t9 S# rSignature Date:- [5 X6 }- d! b$ H" Y1 q
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5 e: u0 N) n9 Y" JDriver B:5 P5 P, \5 y' a# F: _: p
% ~/ D* l' u* y- aSignature Date:
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! X8 I: L2 Z. Y( U0 wWitness:
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Signature Date: |
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