 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。+ p1 o; A% I7 ~1 j: [: G: v
5 s$ J3 h/ L9 B, h. m3 A# iSettlement Disclosure
: Z4 h) c( @9 |0 pFinal Settlement8 @ v& |, F$ f P. |
+ W5 b; U! ^5 j6 |4 yCAR A:7 |" J$ p, g. u8 v9 \, D
Year -6 a9 {% I3 z( y/ r- r/ \; C
Maker/Model -
/ M) u) p: ~% P9 JSerial (VIN) # -
* D' H9 G( Q! h0 D: i, d' ePlate Number:
3 d% v# Y8 k- ?% {# y( l" ?! VDriver Name: (called driver A in this document), }( \9 y4 Q( _: P/ {
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CAR B:
% e, L% G$ U$ d5 K% tYear -
/ r- T1 w) _. ?" d4 rMaker/Model –
0 {* [% D1 M# i+ B0 }+ j9 Y7 |2 t0 LSerial (VIN) # -
' ^' s2 F+ p4 ^! L* j/ }Plate Number:
* }/ \: p4 V$ t4 V/ j2 D1 _. F, f( ~Driver Name: (called driver B in this document)
8 _/ _* K9 f' f$ `# q. r6 j1 j5 e
9 }8 V7 _& j' pIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.6 ^; B2 l( @3 e7 v: Q1 o9 L
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The driver B has paid8 B; s# n, V7 U! |8 z4 P! ^
1. Bumper repair: $2 Q% ^ j6 u! ^- m5 q7 r2 \/ W
2. Other Compensation: $% u% ]1 f' F% K2 \5 j4 H1 q
( _+ O, P. r7 ]1 gdriver A and driver B agree to make a final and permanent settlement of this accident. Driver A has received the above amount of money. And Driver A agrees with this final settlement and is forever giving up the right to claim any responsibility of driver B or to proceed to judicial review by a court, concerning any result of this accident for damage of car A or injury of anyone in it.( R* ]9 @0 \, e
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Driver A:; b# z7 E4 j2 m! j4 i
2 z) B! ?! c6 j4 i, VSignature Date:
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4 M0 X$ \ [; W( }" ^Driver B:
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Signature Date:
# {# F7 F" z$ W
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; X {' i/ u6 Y& m# pWitness:
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Signature Date: |
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