 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
9 e- y: d9 w% m# X; v. V3 B( X+ yFinal Settlement
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Year -$ d* k8 _( C c' `( ~/ ]
Maker/Model -" f2 j$ m& j- {) s A
Serial (VIN) # -' x; x( _5 W, O( L+ y3 k
Plate Number:
' z9 W. |' N& r0 P# K) J1 ^% r6 Y# xDriver Name: (called driver A in this document)
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CAR B:: w# q& I w3 @7 Z* K
Year -
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Serial (VIN) # -% ^( N; U8 p+ r D. _
Plate Number:
* M; B% ~$ q! C+ `% H% Q2 oDriver Name: (called driver B in this document)2 b0 g5 K/ `8 ^: \. d7 F& j
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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
$ r, [/ w4 m9 I5 h0 i% o$ d" |1. Bumper repair: $1 T0 y7 g* a2 b) }# s
2. 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.% |8 N! V. L |1 N! T) o- W- P7 M- `
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Driver A:
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* K, P8 B& u1 U8 h: D( ^6 aSignature Date:
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2 \, W# \8 U) r6 \9 R0 A0 UDriver B:
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Signature Date:/ U& X" e6 z" B3 i e9 B9 Y. d8 Z" w
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Witness:$ \$ c( C1 |; B6 v) N$ I
! \3 D" H/ y3 H% D6 w' L# WSignature Date: |
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