4 x; @7 C; |% S) R1 Gdate. 8 V* ]4 _# W6 Q, r6 V: M 8 u7 ]) w- C. Y) E- a* I" IThis is the full and final payment for the incident between us, XX and XXX at (车祸地点)on (发生车祸的具体时间,哪年哪月那日). The agreed sum of $(你付给对方的钱数)cash for damaged. There is no other claim through insurance or personal for this accident. This is the full and final payment.' p% u7 B) X5 E+ \9 W x# s4 h* k
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Signature of " M/ Y% H! t; I: }
(让对方签名) - b1 \( [2 I6 m* z0 b! i( ?一式两份,对方留一份,然后自己留一份