 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。$ x" v; M. f2 k) d" B" T
. X7 y, R0 u' `/ A' l/ MSettlement Disclosure, F/ Z3 H. q1 a% V! k
Final Settlement/ `8 V2 i* m" l( R3 o0 B
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CAR A:- Z( l* j6 d; C! O4 \% _ Q" v8 f3 y
Year -# z( J! _( P( l* s
Maker/Model -( [8 ?$ m4 ]; v$ _# \$ y
Serial (VIN) # -
9 [& ~/ _$ d4 n" S$ zPlate Number:
% L. I, D& |! m3 ~/ LDriver Name: (called driver A in this document). a" r( V" c7 k" d
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CAR B:4 ^* j" r& Q, w ?' g" t `
Year -/ _3 A N' F$ z, A7 E/ K/ ]. i
Maker/Model –
& G: x! z* n/ C7 L4 rSerial (VIN) # -
! o9 P( o8 b+ ^( E9 ^: tPlate Number:
}3 m( P; H7 `2 C. QDriver Name: (called driver B in this document)0 E- k1 Y6 U( q6 y- \* ^
# x3 j. K/ X: N+ p4 p; D8 RIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.- O1 `3 d7 ?2 j" @2 u
! |& Z2 K! Z, U: k) |6 a; DThe driver B has paid
' C3 S: ]5 F: N1. Bumper repair: $& Z$ c8 w" c7 b( L- F# n; i: ~
2. Other Compensation: $# S, b, C1 s$ n: N, [
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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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Driver A:
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Signature Date:& T8 _0 ~% W7 }7 G! K8 Q
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Driver B:
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Signature Date:4 e* q: x8 |# a2 _; V0 e
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2 b8 [7 ~8 V- ^/ Z5 L EWitness:5 {+ [5 V7 G1 L! ^) |; a4 _& u
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Signature Date: |
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