 鲜花( 3)  鸡蛋( 0)
|
这里有一份
自己酌情改改就可以了。
& F6 L- z; Q2 h& i4 ^4 o# I/ }/ Z ]6 T4 ]' U
Settlement Disclosure
* O) w- W) c! ?8 [1 CFinal Settlement3 v0 g+ n( o4 w9 t( i, U9 f/ a
( H) j) U! \9 X: v
CAR A:9 Y& H- k! D* X1 N: R0 K8 m
Year -
& t q+ i, D# \9 m. `( o' P SMaker/Model -
. Y3 p. m+ b! J, `Serial (VIN) # - ^/ }9 h$ H1 ^% L
Plate Number:( V% L4 N q& d4 g( S
Driver Name: (called driver A in this document)
; U6 O; u+ Z! E
* j1 J, K1 K/ c I: iCAR B:$ {# g: p0 z: C5 A
Year -# r+ k& q9 c5 u# g/ y& ~; E4 m0 y) y
Maker/Model –9 ]4 J: X! U. E3 t2 A- c
Serial (VIN) # -
; X" |+ G% U. N0 f' uPlate Number:
0 g9 r9 c! {& FDriver Name: (called driver B in this document)4 b- A; I* ?1 T4 A+ \! V) v
3 G5 ]/ ]3 K( @/ k9 H
In the afternoon of Nov. 7th, 2007, car B hit the back of car A.9 y; p9 m$ N9 k
0 n# P$ B ~1 ]9 M1 [2 V% R5 iThe driver B has paid
2 y1 ^: ^' v5 ?; Z1. Bumper repair: $# b/ s, _6 t6 m0 ?$ P/ I
2. Other Compensation: $( r" r) _% ?& F
6 J% m/ D' |. [4 {6 {5 u, ^
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.' a2 o7 B7 ?( K T; p* ^
# y5 E, C5 a. v5 j2 h
Driver A:; F4 D! c& y# t% q* X& [
$ ?. }) ~: Q6 d3 e: S9 j sSignature Date:1 \, r8 }! p& I
: G( K. Y) Z& f% @
& n6 {4 @9 H* K' ~Driver B:; a% x" c# ^" _2 K
$ M; k3 B9 E$ c2 j3 CSignature Date:
; |; P" y3 j+ v0 K' j" Z* x: H4 n( \3 n6 d* J j& }2 g& I
2 t8 Q: s/ S* U' e e7 U6 t
Witness:0 w0 Q, @* |! q* O7 {8 i5 [7 Q
5 i: @& j! v% X" Y: _# k: x2 DSignature Date: |
|