 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。- Z# M- V0 r; p: }7 k$ Y
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Settlement Disclosure
6 ^' Q" ]' o8 m SFinal Settlement
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CAR A:
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8 x& ^9 z) k6 T0 ^+ {Maker/Model -
4 A! g+ H a$ {0 p. mSerial (VIN) # -, | U; b' t4 ~2 b H2 n& ~# P
Plate Number: Z n5 g6 D3 i) Z, Q) p0 h
Driver Name: (called driver A in this document)
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CAR B:
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Maker/Model –/ Y' M2 ?. s" O9 e
Serial (VIN) # -# @: E' i u8 [
Plate Number:! A/ I* z7 b' [/ j
Driver Name: (called driver B in this document)
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/ Q9 U/ O# g! |: `; z: `3 JIn the afternoon of Nov. 7th, 2007, car B hit the back of car A.
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1 F7 i' y: f5 k: o2 t$ o @The driver B has paid
, f- _6 V t3 Z! j5 A1. Bumper repair: $7 ]; I/ H7 e% l4 ?8 Z3 Y E: d
2. Other Compensation: $5 Y2 j: z6 y' E7 N) F! m" P5 J
" a. [/ H& z* s" U! vdriver 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.3 y" F7 @, ^- P% `0 w. R& x
, P! ]/ j8 H- ?/ \2 m- w9 l3 \Driver A:
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8 Z1 }9 L) q! J4 ^" H9 j( FSignature Date:
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" K, k/ D" R' T a9 o! b: B8 A; J) EDriver B:
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- @3 d, `% w9 kSignature Date:
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Witness:
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1 R) ^* Z0 C/ ^- _" ISignature Date: |
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